<p>Preoperative aspartate aminotransferase-to-platelet-ratio index as a predictor of posthepatectomy liver failure for resectable hepatocellular carcinoma</p>

Abstract

Purpose This study aimed to investigate the efficacy of preoperative aspartate aminotransferase-to-platelet-ratio index (APRI) score to predict the risk of posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after liver resection, and to compare the discriminatory performance of the APRI with the Child–Pugh score, model for end-stage liver disease (MELD) score, and albumin–bilirubin (ALBI) score. Patients and methods A total of 1,044 consecutive patients with HCC who underwent liver resection were enrolled and studied. Univariate and multivariate analyses were performed to investigate risk factors associated with PHLF. Predictive discrimination of Child–Pugh, MELD, ALBI, and APRI scores for predicting PHLF were assessed according to area under the ROC curve. The cutoff value of the APRI score for predicting PHLF was determined by ROC analysis. APRI scores were stratified by dichotomy to analyze correlations with incidence and grade of PHLF. Results PHLF occurred in 213 (20.4%) patients. Univariate and multivariate analyses revealed that Child–Pugh, MELD, ALBI, and APRI scores were significantly associated with PHLF. Area under the ROC analysis revealed that the APRI score for predicting PHLF was significantly more accurate than Child–Pugh, MELD, or ALBI scores. With an optimal cutoff value of 0.55, the sensitivity and specificity of the APRI score for predicting PHLF were 72.2% and 68.0%, respectively, and the incidence and grade of PHLF in patients with high risk (APRI score >0.55) was significantly higher than in the low-risk cohort (APRI score <0.55). Conclusion The APRI score predicted PHLF in patients with HCC undergoing liver resection more accurately than Child–Pugh, MELD, or ALBI scores.

Comparative Analysis of the Discriminatory Performance of Different Well-Known Risk Assessment Scores for Extended Hepatectomy

“…Mai et al recently evaluated 1,044 hepatocellular carcinoma patients that underwent liver resection, and demonstrated that APRI could significantly predict post-hepatectomy outcomes (AUC = 0.743), in agreement with our results. This confirms the ability of the APRI to predict mortality after EH 27 .…”

“…The APRI was introduced by Wai et al in 2003 as a predictive measure for fibrosis and cirrhosis in patients with chronic hepatitis 25 . Later, different studies concluded that its preoperative measures significantly predict post-hepatectomy morbidity and mortality [26][27][28] . Mai et al recently evaluated 1,044 hepatocellular carcinoma patients that underwent liver resection, and demonstrated that APRI could significantly predict post-hepatectomy outcomes (AUC = 0.743), in agreement with our results.…”

“…The APRI was first introduced as a predictive measure for fibrosis and cirrhosis in patients with chronic hepatitis 25 . Different studies also demonstrated that APRI can significantly predict post-hepatectomy morbidity and mortality [26][27][28] (AST/the upper limit of normal value) × 100 ÷ platelet (10 9 /L) MELD score…”

Artificial Neural Network Model to Predict Post-Hepatectomy Early Recurrence of Hepatocellular Carcinoma without Macroscopic Vascular Invasion

“…Liver resection was performed when the preoperative imaging ndings indicated that all tumors could be resected within the hepatic functional reserve. Detailed and indications for liver resection were illustrated in our previous study [26].…”

Nomogram for prediction of the international study Group of Liver Surgery (ISGLS) grade B/C Posthepatectomy liver failure in HBV-related hepatocellular carcinoma patients: an external validation and prospective application study

“…Nonetheless, further research is necessary as few studies have been done evaluating use of PALBI for predicting PHLF. APRI is noninvasive and reliable for evaluating liver fibrosis and cirrhosis, [ 21 , 22 ] meanwhile a high preoperative APRI score have a high risk of PHLF in HCC patients [ 23 ]. However, APRI only includes two quantitative variables and has no ceiling effect.…”