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A novel combined prognostic nutritional index and aspartate aminotransferase-to-platelet ratio index-based score can predict the survival of patients with hepatocellular carcinoma who undergo hepatic resection

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Abstract

Purpose

Inflammation-, nutrition-, and liver fibrosis-related markers are recognized as prognostic for hepatocellular carcinoma (HCC) patients. This study, therefore, assessed the preoperative prognostic utility of the combination of these markers in patients with HCC.

Methods

This single-center retrospective study included patients who underwent hepatic resection for HCC between 2004 and 2017. A total of 454 patients were divided into training (n = 334) and validation (n = 120) cohorts by random sampling. The predictive impact on surgical outcomes was evaluated using receiver operating characteristic (ROC) curves of these prognostic values in the training cohort.

Results

The prognostic nutritional index (PNI) and aspartate aminotransferase-to-platelet ratio index (APRI) were the strongest diagnostic values (areas under the ROC curves: 0.627 and 0.646, respectively). A scoring system (over 0–2 points) was developed using optimal cutoff values (for PNI < 46.5 scored as 1 point; for APRI > 0.98 scored as 1 point). An increased PNI-APRI score was an independent prognostic factor for both the overall and disease-free survival in HCC patients. Finally, the clinical feasibility of the PNI-APRI score was confirmed in the validation cohort.

Conclusions

The PNI-APRI score is a useful marker for predicting surgical outcomes of HCC patients.

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Abbreviations

AFP:

Alpha-fetoprotein

ALT:

Alanine aminotransferase

APRI:

Aspartate aminotransferase-to-platelet ratio index

AST:

Aspartate aminotransferase

AUC:

Area under the curve

CONUT:

Controlling nutritional status

CRP:

C-reactive protein

CI:

Confidence interval

DCP:

Des-gamma-carboxy prothrombin

DFS:

Disease-free survival

FIB-4:

Fibrosis-4 (index)

HCC:

Hepatocellular carcinoma

ICG-R15:

Indocyanine green dye retention rate at 15 min

LMR:

Lymphocyte–monocyte ratio

MELD:

Model for end-stage liver disease

mGPS:

Modified Glasgow Prognostic Score

NLR:

Neutrophil–lymphocyte ratio

OS:

Overall survival

PALBI:

Platelet–albumin–bilirubin (score)

PLR:

Platelet-to-lymphocyte ratio

PNI:

Prognostic nutritional index

ROC:

Receiver operating characteristic

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Acknowledgements

Source of funding is not applicable. The authors would like to thank Enago (www.enago.jp) for the English language review.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan

    Kyohei Yugawa, Takashi Maeda, Shigeyuki Nagata, Akihiro Sakai, Makoto Edagawa, Takahiro Omine, Takuro Kometani, Shohei Yamaguchi, Kozo Konishi & Kenkichi Hashimoto

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  1. Kyohei Yugawa
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  2. Takashi Maeda
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  3. Shigeyuki Nagata
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  4. Akihiro Sakai
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  5. Makoto Edagawa
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  6. Takahiro Omine
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  7. Takuro Kometani
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  8. Shohei Yamaguchi
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  9. Kozo Konishi
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  10. Kenkichi Hashimoto
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Correspondence to Takashi Maeda.

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Yugawa, K., Maeda, T., Nagata, S. et al. A novel combined prognostic nutritional index and aspartate aminotransferase-to-platelet ratio index-based score can predict the survival of patients with hepatocellular carcinoma who undergo hepatic resection. Surg Today 52, 1096–1108 (2022). https://doi.org/10.1007/s00595-021-02440-0

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