Albumin–Indocyanine Green Evaluation (ALICE) grade combined with portal hypertension to predict post‐hepatectomy liver failure

Abstract

Aim The aim of this study was to evaluate the role of liver function factors in predicting a postoperative large‐volume ascites (LA) and post‐hepatectomy liver failure (PHLF). Methods We included 1025 consecutive patients undergoing hepatectomy for hepatocellular carcinoma between 2002 and 2014. Univariate and multivariate analyses were carried out to evaluate the role of each factor of liver function in predicting LA and PHLF. Factors included the presence of portal hypertension (PH), extent of resection, Model for End‐stage Liver Disease (MELD) score, and Albumin–Indocyanine Green Evaluation (ALICE) grade. Results The ALICE score was the strongest predictor for LA (odds ratio [OR], 5.02) and PHLF (OR, 10.94). Conversely, MELD score was not a significant predictive factor for LA or PHLF based on the multivariate analysis. In the ALICE grade 2 group, patients with PH showed a significantly high incidence of developing LA and experiencing PHLF compared with those without PH (LA, 22.4% vs. 10.3%, P < 0.001; PHLF, 8.6% vs. 1.3%, P < 0.001, respectively). Of patients in the ALICE 2 group, those undergoing sectoriectomy or more extensive resection were associated with extremely poor outcomes (LA, 54.2%; PHLF, 29.2%). Conclusions A combination of ALICE grade and presence of PH is a useful predictor of LA and PHLF.

Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report

“…In the present case, we reduced HVPG to > 10 mmHg before hepatic resection. Sirata et al reported that in the ALICE grade 2 group, patients with PH showed high incidence of large-volume ascites and post-hepatectomy liver failure for HCC [11]. In addition, sectoriectomy or more was also a risk factor to large-volume ascites and liver failure in patients with ALICE grade 2 and PH.…”

“…The ALICE score was calculated by means of the following formula: 0.663 × log10 ICGR15 − 0.718 × albumin (g/dl) [12]. The ALICE grade was stratified as follows: ALICE grade 1, linear predictor value of < − 2.20; ALICE grade 2a, linear predictor value of − 2.20 to − 1.88; ALICE grade 2b, linear predictor value of − 1.88 to − 1.39; and ALICE grade 3, linear predictor value of > − 1.39 [11,12]. The ICGR15 has been widely used in the field of hepatobiliary surgery in Japan.…”

Comparison of new prognostic systems for patients with resectable hepatocellular carcinoma: Albumin‐Bilirubin grade and Albumin‐Indocyanine Green Evaluation grade

“…10 Most recently, Shirata et al suggested in their study that the ALICE score was the strongest predictor for large-volume ascites and liver failure after hepatectomy. 12 In the present study, we evaluated these new systems in terms of their homogeneity, discriminatory ability, AIC, and AUROC regarding overall survival. This method is similar to that used in previous studies comparing the staging of digestive cancer.…”

“…The ALICE score is calculated, including the indocyanine green retention rate at 15 min (ICG R15) and albumin, using the following formula: 0.663 × log 10 ICG R15 (%) – 0.0718 × albumin (g/L), and also divided into three grades by the ALICE grade (cut‐off values of grades 1/2 and 2/3 were −2.20 and −1.39, respectively). To the best of our knowledge, the usefulness of the ALICE grade system has not been substantially considered, and only a few articles have compared these two grading systems …”

“…To the best of our knowledge, the usefulness of the ALICE grade system has not been substantially considered, and only a few articles have compared these two grading systems. [10][11][12] In the present study, we investigated the utility of the ALBI and ALICE grades as a validation cohort, and compared the prognostic impact of these systems on patients with resectable HCC using a multi-institutional database.…”