Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2020; 26(7): 749-758
Published online Feb 21, 2020. doi: 10.3748/wjg.v26.i7.749
Modified Child-Pugh grade vs albumin-bilirubin grade for predicting prognosis of hepatocellular carcinoma patients after hepatectomy
Feng Huang, Jian Gao
Feng Huang, Second Clinical College, Chongqing Medical University, Chongqing 400010, China
Jian Gao, Department of Gastroenterology, Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
Author contributions: Huang F conceptualized and designed the study, acquired, analysed, and interpreted the data, and drafted the manuscript; Gao J conceptualized and designed the study, and critically revised the manuscript for important intellectual content; all authors approved the final version of the manuscript.
Supported by National Natural Science Foundation of China, No. 81572888.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Second Affiliated Hospital of Chongqing Medical University (No. 2018-025).
Informed consent statement: All study participants gave their informed consent prior to study enrollment (by written or verbal).
Conflict-of-interest statement: None declared.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Jian Gao, PhD, Professor, Chief Doctor, Department of Gastroenterology, Second Affiliated Hospital, Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing 400010, China. 982213482@qq.com
Received: November 28, 2019
Peer-review started: November 28, 2019
First decision: December 28, 2019
Revised: January 7, 2020
Accepted: January 11, 2020
Article in press: January 11, 2020
Published online: February 21, 2020
Processing time: 84 Days and 8.9 Hours
Abstract
BACKGROUND

Hepatectomy is the main treatment for patients with hepatocellular carcinoma (HCC) and it has a high possibility for long-term cure potential. But the postoperative mortality and recurrence rates remain high. Since the long-term prognosis of HCC patients is strongly linked to liver function, preoperative assessment of liver function is very important for HCC patients.

AIM

To compare the predictive power of the modified Child-Pugh (MCP) and albumin-bilirubin (ALBI) grades for the long-term outcome of HCC.

METHODS

From January 2010 to June 2017, a total of 204 patients with HCC who underwent surgery at the Second Affiliated Hospital of Chongqing Medical University were enrolled in this retrospective study. Multivariate Cox regression analysis was used to determine the independent predictive factors of survival and relapse. The area under the curve (AUC) was used to evaluate the discriminative performance of the MCP grade and ALBI grade to predict the postoperative overall survival (OS) time and recurrence-free survival (RFS) time.

RESULTS

The median OS and RFS times were 44.0 mo (range: 22.0-74.0 mo) and 22.0 mo (range: 5.0-45.0 mo), respectively. The median OS and RFS times of MCP grades 1, 2, and 3 patients were 60.0, 39.0, and 18.0 mo (P < 0.001) and 36.0, 15.0, and 7.0 mo (P < 0.001), respectively. The median OS and RFS times of ALBI grades 1, 2, and 3 patients were 56.0, 26.0, and 6.0 mo (P < 0.001) and 25.0, 10.0, and 3.0 mo (P = 0.003), respectively. Both the MCP and ALBI grades were more accurate than the Child-Pugh grade for predicting long-term prognosis. Further analysis demonstrated that for both predicting OS and RFS, the MCP grade performed better than the ALBI grade (AUC: 0.642 vs 0.605 for OS; 0.659 vs 0.594 for RFS).

CONCLUSION

The MCP grade is more accurate than the ALBI grade for predicting long-term outcome of patients with HCC.

Keywords: Modified Child-Pugh grade; Albumin-Bilirubin grade; Hepatocellular carcinoma; Prognosis; Hepatectomy; Child-Pugh

Core tip: We discovered that only a few studies have evaluated the predictive power of prealbumin-involving modified Child-Pugh (MCP) grade for the prognosis of patients with hepatocellular carcinoma (HCC). The objective, recognizable, and simple method, the albumin-bilirubin (ALBI) grade, for predicting the long-term prognosis of HCC patients has been widely proven in the international environment. In this study, receiver operating characteristics curve analysis showed that the MCP grade had higher accuracy than the ALBI grade, and the area under the curve of the MCP grade was larger than that of the ALBI grade. The MCP grade may be the best tool for the selection of HCC treatment strategies.