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
ARTICLE HIGHLIGHTS
Research background

Liver resection is the main treatment for hepatocellular carcinoma (HCC) patients 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.

Research motivation

The main aim of this study was to compare the predictive power of the modified Child-Pugh (MCP) and albumin-bilirubin (ALBI) grades for the long-term outcome of HCC.

Research objectives

We can provide a more effective, objective, and simple method to assess the prognosis of HCC patients undergoing hepatectomy and makes it easier and more accurate for surgeons to select suitable HCC patients for hepatectomy.

Research methods

A total of 204 patients with HCC who underwent surgery were enrolled in this retrospective study, the median follow-up time was 36 mo. Multivariate Cox regression analysis was used to determine the independent predictive factors for survival and relapse. The area under the curve 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.

Research results

Both the MCP and ALBI grades were more accurate than the Child-Pugh grade for predicting long-term prognosis. And further analysis demonstrated that for both predicting OS and RFS, the MCP grade performed better than the ALBI grade. This can provide a more effective, objective, and simple tool for the selection of HCC treatment strategies.

Research conclusions

We found that the new grading system, MCP grade, had predictive value for the long-term prognosis of HCC patients after hepatectomy. Both the MCP and ALBI scoring systems are objective, simple, and discriminative, and the ALBI grade has been widely proven in the international environment for predicting the long-term prognosis of HCC patients. We hypothesized that the MCP grade is superior to the ALBI grade in predicting the prognosis of HCC patients. In this study, we adopted the traditional method to prove the hypothesis, and we found a new phenomenon in which there was no patient in Child-Pugh grade C, and there were few patients in ALBI grade 3, but the patient distribution of MCP grade was relatively uniform. And eventually through the patient distribution, Kaplan-Meier curves and ROC curves of the MCP and ALBI grades and so on, we confirmed the hypothesis that the MCP grade is superior to the ALBI. But in this study, the sample size is not very large, the patients were from one clinical center, and it is a retrospective study, so in the future, we can further confirm the value of MCP in predicting the prognosis of HCC patients through larger samples, multi-center studies and prospective studies. When evaluating liver function of HCC patients before surgery, we should pay more attention to the serum PA levels of patients, and we can choose the MCP grade to assess the prognosis of patients.

Research perspectives

Larger samples, multi-center studies and prospective studies are needed to further validate the value of the MCP grade for the long-term prognosis of HCC patients. And how to improve the liver function of the HCC patients with a higher MCP grade to further improve the prognosis of HCC patients after surgery remains a question that needs to be answered in future studies.