Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2024; 16(5): 1763-1772
Published online May 15, 2024. doi: 10.4251/wjgo.v16.i5.1763
Albumin–bilirubin grade as a predictor of survival in hepatocellular carcinoma patients with thrombocytopenia
Zhong-Ran Man, Xuan-Kun Gong, Kang-Lin Qu, Qing Pang, Bin-Quan Wu
Zhong-Ran Man, Xuan-Kun Gong, Kang-Lin Qu, Qing Pang, Bin-Quan Wu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
Qing Pang, Department of Hepatobiliary Surgery, Anhui No. 2 Provincial People’s Hospital, Hefei 230041, Anhui Province, China
Co-corresponding authors: Qing Pang and Bin-Quan Wu.
Author contributions: Man ZR and Gong XK contributed to the manuscript preparation; Qu KL helped to perform the statistical analysis and the literature research; Man ZR and Gong XK contributed to data collection and analysis. Both Pang Q and Wu BQ have played important and indispensable roles in the study design, data analysis and manuscript preparation as the co-corresponding authors. Pang Q conceptualized, designed, and supervised the whole process of the research. Wu BQ was responsible for data re-analysis, figures and tables plotting, literature search, and preparation of the final version of the manuscript. This collaboration between Pang Q and Wu BQ is crucial for the publication of this manuscript.
Supported by Key Projects of Natural Science Foundation of Bengbu Medical College, No. 2021byzd050; and Science and Technological Fund of Anhui Province for Outstanding Youth, No. 2008085J37.
Institutional review board statement: This study received approval from the institutional review board at Bengbu Medical College, No. 2019-055.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to operation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Participants gave informed consent for data sharing at portxiu2@126.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin-Quan Wu, MD, Professor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, No. 801 Zhihuai Road, Bengbu 233000, Anhui Province, China. liumulin66@126.com
Received: December 28, 2023
Peer-review started: December 28, 2023
First decision: January 17, 2024
Revised: February 2, 2024
Accepted: March 25, 2024
Article in press: March 25, 2024
Published online: May 15, 2024
Processing time: 133 Days and 11 Hours
Abstract
BACKGROUND

The models for assessing liver function, mainly the Child–Pugh (CP), albuminbilirubin (ALBI), and platelet–ALBI (PALBI) classifications, have been validated for use in estimating the prognosis of hepatocellular carcinoma (HCC) patients. However, thrombocytopenia is a common finding and may influence the prognostic value of the three models in HCC.

AIM

To investigate and compare the prognostic performance of the above three models in thrombocytopenic HCC patients.

METHODS

A total of 135 patients with thrombocytopenic HCC who underwent radical surgery were retrospectively analyzed. Preoperative scores on the CP, ALBI and PALBI classifications were estimated accordingly. Kaplan–Meier curves with log-rank tests and Cox regression models were used to explore the significant factors associated with overall survival (OS) and recurrence-free survival (RFS).

RESULTS

The preoperative platelet counts were significantly different among the CP, ALBI and PALBI groups. After a median follow-up of 28 mo, 39.3% (53/135) of the patients experienced postoperative recurrence, and 36.3% (49/135) died. Univariate analysis suggested that α-fetoprotein levels, tumor size, vascular invasion, and ALBI grade were significant predictors of OS and RFS. According to the multivariate Cox regression model, ALBI was identified as an independent prognostic factor. However, CP and PALBI grades were not statistically significant prognostic indicators.

CONCLUSION

The ALBI grade, rather than CP or PALBI grade, is a significant prognostic indicator for thrombocytopenic HCC patients.

Keywords: Hepatocellular carcinoma; Thrombocytopenia; Child-Pugh; Albumin-bilirubin; Platelet-albumin-bilirubin

Core Tip: Thrombocytopenia is a common finding in hepatocellular carcinoma (HCC) and may influence the prognostic value of the Child–Pugh (CP), albumin–bilirubin (ALBI), and platelet–ALBI (PALBI) grade. We showed that the preoperative platelet count was significantly different among the different CP, ALBI and PALBI groups of thrombocytopenic HCC patients. The statistically significant prognostic model was verified to be ALBI, rather than CP or PALBI. Therefore, ALBI grade is a significant prognostic indicator for thrombocytopenic HCC patients.