Kaibori Masaki, Hiraoka Atsushi, Iida Hiroya, Komeda Koji, Hirokawa Fumitoshi, Ueno Masaki, Kosaka Hisashi, Matsui Kosuke, 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 Apr 22;14(9):2091. doi: 10.3390/cancers14092091.
Nutritional assessment is important for predicting a prognosis in hepatocellular carcinoma (HCC). The authors examined the utility of the recently developed neo-Glasgow prognostic score (GPS) as a nutritional prognostic assessment in HCC in a multicenter retrospective study of 271 patients with HCC and Child-Pugh class A liver function who underwent R0 resection between 2011 and 2013. The median age was 72 years, 229 and 42 patients had Child-Pugh scores of 5 and 6, respectively, 223 patients had single tumors, the median tumor size was 3.6 cm, and open and laparoscopic resection were performed in 138 and 133 patients, respectively. We compared the prognostic predictive utility of the prognostic nutritional index, neutrophil/lymphocyte and platelet/lymphocyte ratios, controlling nutritional status score, GPS, and neo-GPS, which uses albumin-bilirubin grade (ALBI) instead of albumin. The c-indexes for the predictive prognostic value for overall survival (OS) and progression-free survival (PFS) were best for neo-GPS (OS: 0.571 vs. ≤0.555; PFS: 0.555 vs. ≤0.546). In multivariate analysis with the Cox proportional hazards model, elevated alpha-fetoprotein (AFP; ≥100 ng/mL; hazard ratio [HR] 2.190, 95% confidence interval [CI] 1.493−3.211, p < 0.001), multiple tumors (HR 1.784, 95%CI 1.178−2.703, p = 0.006), tumor size of ≥5 cm (HR 1.508, 95%CI 1.037−2.193, p = 0.032), and neo-GPS of ≥1 (HR 1.554, 95%CI 1.074−2.247, p = 0.019) were significant prognostic factors for OS, whereas elevated AFP (≥100 ng/mL) (HR 1.743, 95%CI 1.325−2.292, p < 0.001), multiple tumors (HR 1.537, 95%CI 1.148−2.057, p = 0.004), and neo-GPS of ≥1 (HR 1.522, 95%CI 1.186−1.954, p = 0.001) were significant prognostic factors for PFS. A neo-GPS of ≥1 was associated with a higher rate of high-grade (≥3) Clavien-Dindo complications than a neo-GPS of <1 (31.1% vs. 17.0%, p = 0.007). Neo-GPS was a good prognostic nutritional assessment tool for the prediction of postoperative complications and prognosis in patients undergoing surgical HCC resection.
营养评估对于预测肝细胞癌（HCC）的预后很重要。作者在一项多中心回顾性研究中，对2011年至2013年间接受R0切除的271例肝功能为Child-Pugh A级的HCC患者，研究了最近开发的新格拉斯哥预后评分（GPS）作为HCC营养预后评估的效用。患者中位年龄为72岁，Child-Pugh评分为5分和6分的患者分别有229例和42例，223例患者为单发病灶，肿瘤中位大小为3.6 cm，138例和133例患者分别接受了开放手术和腹腔镜手术切除。我们比较了预后营养指数、中性粒细胞/淋巴细胞和血小板/淋巴细胞比值、控制营养状态评分、GPS以及使用白蛋白-胆红素分级（ALBI）代替白蛋白的新GPS对预后的预测效用。新GPS对总生存期（OS）和无进展生存期（PFS）的预测预后价值的c指数最佳（OS：0.571对≤0.555；PFS：0.555对≤0.546）。在Cox比例风险模型的多因素分析中，甲胎蛋白（AFP）升高（≥100 ng/mL；风险比[HR] 2.190，95%置信区间[CI] 1.493−3.211，p < 0.001）、多发肿瘤（HR 1.784，95%CI 1.178−2.703，p = 0.006）、肿瘤大小≥5 cm（HR 1.508，95%CI 1.037−2.193，p = 0.032）以及新GPS≥1（HR 1.554，95%CI 1.074−2.247，p = 0.019）是OS的显著预后因素，而AFP升高（≥100 ng/mL）（HR 1.743，95%CI 1.325−2.292，p < 0.001）、多发肿瘤（HR 1.537，95%CI 1.148−2.057，p = 0.004）以及新GPS≥1（HR 1.522，95%CI 1.186−1.954，p = 0.001）是PFS的显著预后因素。新GPS≥1的患者比新GPS<1的患者发生高级别（≥3级）Clavien-Dindo并发症的发生率更高（31.1%对17.0%，p = 0.007）。新GPS是预测接受手术切除HCC患者术后并发症和预后的良好营养预后评估工具。
