Kaibori Masaki, Hiraoka Atsushi, Matsui Kosuke, Matsushima Hideyuki, Kosaka Hisashi, Yamamoto Hidekazu, Yamaguchi Takashi, Yoshida Katsunori, Sekimoto Mitsugu
Department of Surgery, Kansai Medical University, Osaka 573-1191, Japan.
Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama 790-0024, Japan.
Cancers (Basel). 2022 Mar 9;14(6):1402. doi: 10.3390/cancers14061402.
Background/Aim: Nutritional assessment is known to be important for predicting prognosis in patients with malignant diseases. This study examined the usefulness of a prognostic predictive nutritional assessment tool for hepatocellular carcinoma (HCC) patients treated with surgical resection. Materials/Methods: HCC patients (n = 429) classified as Child−Pugh A who underwent an R0 resection between 2010 and 2020 were retrospectively analyzed (median age 73 years, males 326 (76.0%), Child−Pugh score 5:6 = 326:103, single tumor 340 (79.2%), median tumor size 3.5 cm, open:laparoscopic = 304:125). Glasgow prognostic score (GPS) and the newly developed neo-GPS method, which uses albumin−bilirubin grade 1 instead of albumin, were evaluated to compare their usefulness for prognosis prediction. Results: Median survival time for patients with a GPS score of 0, 1, and 2 was 120, 51, and 20 months, respectively. As for neo-GPS, that for those with a score of 0, 1, and 2 was not applicable (NA), 53 months, and 35 months, respectively (each p < 0.001; c-index: 0.556 and 0.611, respectively). Furthermore, median progression-free survival was 33, 22, and 9 months, and 41, 24, and 15 months, respectively (each p < 0.001; c-index: 0.539 and 0.578, respectively). As compared to patients with a high GPS (≥1), those with a high neo-GPS (≥1) showed a greater rate of high Clavien−Dindo classification (≥3) (39.2% vs. 65.1%). A comparison of patients with a high GPS (≥1) with those with a high neo-GPS (≥1) showed no significant difference regarding frequency of open or laparoscopic hepatectomy (17.4% vs. 15.2%, p = 0.670; 44.7% vs. 43.2%, p = 0.831, respectively), while the frequency of high Clavien−Dindo classification (≥3) was lower in patients who underwent a laparoscopic hepatectomy (11.2% vs. 22.7%, p = 0.007). Conclusion: The present findings suggest that the newly developed neo-GPS based on ALBI grade is an effective prognostic nutritional assessment tool and can be used for prediction of postoperative complications.
背景/目的：营养评估对于预测恶性疾病患者的预后很重要。本研究探讨了一种预后预测营养评估工具对接受手术切除的肝细胞癌（HCC）患者的实用性。
材料/方法：回顾性分析2010年至2020年间接受R0切除的429例Child-Pugh A级HCC患者（中位年龄73岁，男性326例（76.0%），Child-Pugh评分5:6 = 326:103，单发肿瘤340例（79.2%），中位肿瘤大小3.5 cm，开腹：腹腔镜 = 304:125）。评估格拉斯哥预后评分（GPS）和新开发的neo-GPS方法（该方法使用白蛋白-胆红素分级1代替白蛋白），以比较它们对预后预测的实用性。
GPS评分为0、1和2的患者的中位生存时间分别为120、51和20个月。对于neo-GPS，评分为0、1和2的患者的中位生存时间分别为不可用（NA）、53个月和35个月（各p < 0.001；c指数分别为0.556和0.611）。此外，无进展生存期的中位数分别为33、22和9个月，以及41、24和15个月（各p < 0.001；c指数分别为0.539和0.578）。与GPS高（≥1）的患者相比，neo-GPS高（≥1）的患者Clavien-Dindo分级高（≥3）的比例更高（39.2%对65.1%）。GPS高（≥1）的患者与neo-GPS高（≥1）的患者在开腹或腹腔镜肝切除术的频率方面无显著差异（分别为17.4%对15.2%，p = 0.670；44.7%对43.2%，p = 0.831），而接受腹腔镜肝切除术的患者中Clavien-Dindo分级高（≥3）的频率较低（11.2%对22.7%，p = 0.007）。
目前的研究结果表明，基于ALBI分级新开发的neo-GPS是一种有效的预后营养评估工具，可用于预测术后并发症。
