Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2017; 23(5): 853-858
Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.853
Preoperative albumin level is a marker of alveolar echinococcosis recurrence after hepatectomy
Gaëtan-Romain Joliat, Ismail Labgaa, Nicolas Demartines, Nermin Halkic
Gaëtan-Romain Joliat, Ismail Labgaa, Nicolas Demartines, Nermin Halkic, Department of Visceral Surgery, University Hospital CHUV, 1011 Lausanne, Switzerland
Author contributions: Joliat GR, Labgaa I, Demartines N and Halkic N designed the study; Joliat GR acquired the data; Joliat GR, Labgaa I, Demartines N and Halkic N analyzed and interpreted the results; Joliat GR drafted the manuscript; Labgaa I, Demartines N and Halkic N revised the manuscript; Joliat GR, Labgaa I, Demartines N and Halkic N approved the final version.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the University Hospital of Lausanne.
Informed consent statement: All patients provided informed written consent about medical data collection and publication.
Conflict-of-interest statement: All the authors state that they have no conflict of interest related to this manuscript.
Data sharing statement: The original anonymized dataset is available on request from the corresponding author at demartines@chuv.ch.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicolas Demartines, MD, FACS, FRCS, Professor, Chairman of the Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland. demartines@chuv.ch
Telephone: +41-21-3142400 Fax: +41-21-3142411
Received: July 30, 2016
Peer-review started: August 2, 2016
First decision: October 20, 2016
Revised: November 6, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 7, 2017
Processing time: 176 Days and 10.7 Hours
Abstract
AIM

To identify a preoperative blood marker predictive of alveolar echinococcosis (AE) recurrence after hepatectomy.

METHODS

All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital (CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume (MCV), red blood cell distribution width (RDW), thrombocytes, C-reactive protein (CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic (ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrence-free survival curves were calculated using the Kaplan-Meier method.

RESULTS

The cohort included 68 adult patients (37 females) with median age of 61 years [interquartile range (IQR): 46-71]. Eight of the patients (12%) presented a recurrence over a median follow-up time of 76 mo (IQR: 34-128). Median time to recurrence was 10 mo (IQR: 6-11). Median preoperative leukocyte, MCV, RDW, thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L (IQR: 41-45) for non-recurrent cases and 36 g/L (IQR: 33-42) for recurrent cases (P = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840 (95%CI: 0.642-1, P = 0.002). The cut-off albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence (HR = 0.099, P = 0.007 and HR = 0.182, P = 0.045 respectively).

CONCLUSION

Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up.

Keywords: Liver surgery; Alveolar echinococcosis; Albumin; Predictive marker; Recurrence

Core tip: This study assessed different blood markers as potential preoperative predictors of recurrence of alveolar echinococcosis (AE) after liver resection. A preoperative serum albumin level of < 37.5 g/L was found to be associated with AE recurrence after liver resection. Preoperative albumin level is easy to obtain and could represent a useful tool to guide postoperative follow-up after hepatectomy for AE.