• APRI score
• Cirrhosis
• Liver resection
• Robotic surgery

• Humans
• Hepatectomy/methods
• Robotic Surgical Procedures/methods
• Liver Neoplasms/surgery
• Liver Neoplasms/blood
• Male
• Female
• Aspartate Aminotransferases/blood
• Middle Aged
• Platelet Count
• Aged
• Treatment Outcome
• Liver Cirrhosis/blood
• Liver Cirrhosis/diagnosis
• Retrospective Studies
• Adult
• Blood Loss, Surgical

• aspartate aminotransferase to platelet ratio index
• cardiogenic shock
• intensive care unit
• predict

• Controlled low central venous pressure
• Laparoscopic hepatectomy
• Posthepatectomy liver failure
• Propensity score matching
• Venous gas embolism

• Humans
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Male
• Female
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Middle Aged
• Propensity Score
• Retrospective Studies
• Central Venous Pressure
• Incidence
• Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Liver Failure/etiology
• Liver Failure/epidemiology
• Liver Failure/prevention & control
• Risk Factors
• Adult

• 2023A04J2102 the Science and Technology Projects in Guangzhou

• Humans
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/diagnosis
• Liver Neoplasms/therapy
• Liver Neoplasms/diagnosis
• Liver Transplantation/methods
• Practice Guidelines as Topic
• Disease Management
• Risk Assessment

• blood‐based liver fibrosis markers
• hepatocellular carcinoma
• initial curative hepatectomy
• liver fibrosis
• steatosis‐associated fibrosis estimator score

• Japan Agency for Medical Research and Development
• Japan Society for the Promotion of Science

• Clinical liver test
• HCC therapy
• functional liver test
• hepatocellular carcinoma
• liver cirrhosis
• prognosis

• Humans
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/physiopathology
• Liver Neoplasms/therapy
• Liver Neoplasms/physiopathology
• Liver Neoplasms/pathology
• Liver Function Tests
• Liver/physiopathology
• Liver/diagnostic imaging
• Liver/pathology
• Prognosis
• Predictive Value of Tests

• ALPPS
• Future liver remnant
• LVD
• Liver hypertrophy
• Liver regeneration
• Liver venous deprivation
• PHLF
• Portal vein embolization

• Humans
• Hepatectomy/methods
• Liver Regeneration
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Liver/surgery
• Liver/pathology
• Liver/diagnostic imaging
• Hypertrophy
• Liver Failure/etiology
• Liver Failure/surgery
• Organ Size
• Postoperative Complications
• Prognosis

• Intrahepatic cholangiocarcinoma
• Monocyte-to-lymphocyte ratio
• Prognosis
• Surgery

• Humans
• Cholangiocarcinoma/surgery
• Cholangiocarcinoma/blood
• Cholangiocarcinoma/mortality
• Cholangiocarcinoma/pathology
• Male
• Hepatectomy
• Female
• Monocytes
• Middle Aged
• Retrospective Studies
• Bile Duct Neoplasms/surgery
• Bile Duct Neoplasms/blood
• Bile Duct Neoplasms/mortality
• Bile Duct Neoplasms/pathology
• Prognosis
• Aged
• Lymphocytes
• Adult
• Preoperative Period
• Biomarkers, Tumor/blood
• ROC Curve
• Disease-Free Survival

• GuiKe AD22035057 the Specific Research Project of Guangxi for Research Bases and Talents
• GuiKe AD22035057 the Specific Research Project of Guangxi for Research Bases and Talents
• GuiKe AD22035057 the Specific Research Project of Guangxi for Research Bases and Talents
• GuiKe AD22035057 the Specific Research Project of Guangxi for Research Bases and Talents
• GuiKe AD22035057 the Specific Research Project of Guangxi for Research Bases and Talents
• GKE-ZZ202217 the Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education
• GKE-ZZ202217 the Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education
• GKE-ZZ202217 the Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education
• GKE-ZZ202217 the Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education
• GKE-ZZ202217 the Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education
• GZSY23-66 Guangxi TCM appropriate technology development and promotion project
• GZSY23-66 Guangxi TCM appropriate technology development and promotion project
• GZSY23-66 Guangxi TCM appropriate technology development and promotion project
• GZSY23-66 Guangxi TCM appropriate technology development and promotion project
• GZSY23-66 Guangxi TCM appropriate technology development and promotion project
• NO.2023-7 Youth Program of Scientific Research Foundation of Guangxi Medical University Cancer Hospital
• NO.2023-7 Youth Program of Scientific Research Foundation of Guangxi Medical University Cancer Hospital

• nomogram
• post-hepatectomy liver failure
• serum concentration of type IV collagen 7s domain

• APRI-score
• De Ritis
• MCC
• MELD
• biomarkers
• carcinoma
• liver
• neuroendocrine
• skin cancer
• tumor metabolism

• ALBI
• APRI
• Child–Pugh
• FIB-4
• HCC
• MELD
• PALBI
• PHLF
• hepatocellular carcinoma

• COVID-19
• Hepatitis B virus
• Liver function
• Meta-analysis

• Humans
• Hepatitis B virus
• Pandemics
• COVID-19
• Hepatitis B/epidemiology
• Bilirubin

• Humans
• Hepatectomy/adverse effects
• Cohort Studies
• Retrospective Studies
• Postoperative Complications/diagnosis
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Liver Failure/diagnosis
• Liver Failure/etiology
• Liver Neoplasms/surgery
• Carcinoma, Hepatocellular/surgery

• Hepatocellular carcinoma
• Liver resection
• Post-hepatectomy liver failure
• Spleen volume-to-platelet ratio

• Colorectal neoplasms
• Liver failure
• Metastases
• Sinusoidal obstructive syndrome

• Aspartate Aminotransferases
• Colorectal Neoplasms/pathology
• Hepatectomy/adverse effects
• Hepatic Insufficiency
• Humans
• Liver Failure/surgery
• Liver Neoplasms/pathology
• Platelet Count
• Postoperative Complications/etiology
• Retrospective Studies

• hepatocellular carcinoma
• nomogram
• post-hepatectomy liver failure
• predictive model

• received no financial support

• the Natural Science Foundation of Guangxi

Systemic inflammatory response (SIR) plays a crucial role in every step of tumorigenesis and development. More recently, the fibrinogen-to-albumin ratio (FAR), an inflammation-based model, was suggested as a prognostic maker for various cancer patients. This research aimed to estimate the prognostic abilities of FAR, neutrophil–lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet– lymphocyte ratio (PLR), and systemic immune–inflammation index (SII) in patients with hepatocellular carcinoma (HCC) subjected to curative hepatectomy.

A total of 1,502 cases who underwent hepatectomy for HCC were included. The predictive performances of FAR, NLR, MLR, PLR and SII were assessed with regards to overall survival (OS) and disease-free survival (DFS). The area under the time-dependent receiver operating characteristic curve was used to compare prognostic performances.

Data revealed that FAR had higher predictive accuracy than other inflammation-based models and alpha-fetoprotein (AFP) in assessing OS and DFS. Indeed, the OS and DFS of patients with high FAR (> 8.9), differentiated by the optimal cut-off value of FAR, were remarkably reduced (p < 0.05 for OS and DFS). Multivariate Cox regression analyses identified that AFP, FAR, clinically significant portal hypertension, tumor size, Barcelona Clinical Liver Cancer staging system, major resection and blood loss were independent indicators for predicting OS and DFS. Furthermore, these patients could be classified according to their FAR into significantly different subgroups, regardless of AFP levels (p < 0.05 for DFS and OS). Similar results were obtained in other inflammation-based prognostic models.

Compared with NLR, MLR, PLR, SII and AFP, FAR showed significant advantages in predicting survival of HCC patients subjected to liver resection.

The online version contains supplementary material available at 10.1186/s12876-022-02328-4.

• Fibrinogen-to-albumin ratio
• Hepatocellular carcinoma
• Prognosis
• Systemic inflammation response

Sarcopenia, which is defined as a loss of skeletal muscle mass, function and strength, is the result of major metabolic changes often observed in advanced liver disease. Its evaluation mirrors the nutritional and functional status of the patients, and thus has been recently implicated as an outcome predictor of patients with liver diseases and hepatocellular carcinoma. This study provides evidence that sarcopenia, as assessed by the skeletal muscle index, is associated with age and body mass index in liver surgery candidates. More importantly, it is associated with higher rates of major complications (Clavien-Dindo grade III or IV) in patients with compensated advanced chronic liver disease and/or portal hypertension undergoing liver resection for primary hepatocellular carcinoma.

The burden of post-operative complications of patients undergoing liver resection for hepatocellular carcinoma (HCC) is a cause of morbidity and mortality. Recently, sarcopenia has been reported to influence the outcome of patients with cirrhosis. We aimed to assess factors associated with sarcopenia and its prognostic role in liver surgery candidates. We included all patients with compensated advanced chronic liver disease (cACLD) undergoing liver resection for primary HCC consecutively referred to the University of Bologna from 2014 to 2019 with an available preoperative abdominal CT-scan performed within the previous three months. A total of 159 patients were included. The median age was 68 years, and 80.5% of the patients were male. Sarcopenia was present in 82 patients (51.6%). Age and body mass index (BMI) were associated with the presence of sarcopenia at multivariate analysis. Thirteen (8.2%) patients developed major complications and 14 (8.9%) presented PHLF grade B-C. The model for end-stage liver disease score was associated with the development of major complications, whereas cACLD presence, thrombocytopenia, portal hypertension (PH), Child-Pugh score and Albumin-Bilirubin score were found to be predictors of clinically significative PHLF. The rate of major complications was 11.8% in sarcopenic patients with cACLD compared with no complications (0%) in patients without sarcopenia and cACLD (p = 0.032). The rate of major complications was significantly higher in patients with (16.3%) vs. patients without (0%) sarcopenia (p = 0.012) in patients with PH. In conclusion, sarcopenia, which is associated with age and BMI, may improve the risk stratification of post-hepatectomy major complications in patients with cACLD and PH.

• hepatocellular carcinoma
• liver resection
• post-hepatectomy liver failure
• sarcopenia

• Albumin-bilirubin
• Aspartate transaminase to platelet ratio index
• Hepatocellular carcinoma
• Liver resection
• Post-hepatectomy liver failure
• Prediction

• Albumins
• Bilirubin
• Biomarkers
• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/surgery
• End Stage Liver Disease
• Hepatectomy
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/surgery
• Platelet Count
• Retrospective Studies
• Severity of Illness Index
• Transaminases

• Hepatocellular carcinoma (HCC)
• Model for End-stage Liver Disease (MELD)
• cholangiocarcinoma
• liver resection
• outcomes

• Albumin-bilirubin
• Liver resection
• Mortality
• Posthepatectomy liver failure

• ALBI
• PHLF
• albumin-bilirubin
• hepatectomy
• hepatocellular carcinoma
• liver failure
• liver surgery

• Artificial neural network
• Curative hepatectomy
• Early recurrence
• Hepatocellular carcinoma
• Prognostic factors

• Carcinoma, Hepatocellular/diagnosis
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Disease-Free Survival
• Female
• Follow-Up Studies
• Hepatectomy
• Humans
• Liver/diagnostic imaging
• Liver/pathology
• Liver/surgery
• Liver Neoplasms/diagnosis
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/prevention & control
• Neoplasm Staging
• Neural Networks, Computer
• Nomograms
• Postoperative Period
• Predictive Value of Tests
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors

• 81803007 National Science Foundation of China Youth Fund Project
• 81660498 Regional science fund project of China natural science foundation
• 2019M663412 66th Chinese Post-Doctoral Science Foundation Project
• 2019JJA140151 Project of GuangXi Natural Science Foundation
• 2017GXNSFBA198234 Project of GuangXi Natural Science Foundation

Objectives: Preoperative prediction of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) is significant for developing appropriate treatment strategies. We aimed to establish a radiomics-based clinical model for preoperative prediction of PHLF in HCC patients using gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI).

Methods: A total of 144 HCC patients from two medical centers were included, with 111 patients as the training cohort and 33 patients as the test cohort, respectively. Radiomics features and clinical variables were selected to construct a radiomics model and a clinical model, respectively. A combined logistic regression model, the liver failure (LF) model that incorporated the developed radiomics signature and clinical risk factors was then constructed. The performance of these models was evaluated and compared by plotting the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC) with 95% confidence interval (CI).

Results: The radiomics model showed a higher AUC than the clinical model in the training cohort and the test cohort for predicting PHLF in HCC patients. Moreover, the LF model had the highest AUCs in both cohorts [0.956 (95% CI: 0.955–0.962) and 0.844 (95% CI: 0.833–0.886), respectively], compared with the radiomics model and the clinical model.

Conclusions: We evaluated quantitative radiomics features from MRI images and presented an externally validated radiomics-based clinical model, the LF model for the prediction of PHLF in HCC patients, which could assist clinicians in making treatment strategies before surgery.

• hepatocellular carcinoma
• magnetic resonance imaging
• post-hepatectomy liver failure
• prediction model
• radiomics

• APRI
• FLR
• HCC
• Hepatic functional reserve
• PHLF

• Aspartate Aminotransferases
• Carcinoma, Hepatocellular/surgery
• End Stage Liver Disease
• Hepatectomy
• Humans
• Liver Neoplasms/surgery
• ROC Curve
• Retrospective Studies
• Severity of Illness Index

Post-hepatectomy liver failure (PHLF) increases morbidity and mortality after liver resection for patients with advanced liver fibrosis and cirrhosis. Preoperative liver stiffness using two-dimensional shear wave elastography (2D-SWE) is widely used to evaluate the degree of fibrosis. However, the 2D-SWE results were not accurate. A durometer measures hardness by quantifying the ability of a material to locally resist the intrusion of hard objects into its surface. However, the durometer score can only be obtained during surgery.

To measure correlations among 2D-SWE, palpation by surgeons, and durometer-measured objective liver hardness and to construct a liver hardness regression model.

We enrolled 74 hepatectomy patients with liver hardness in a derivation cohort. Tactile-based liver hardness scores (0-100) were determined through palpation of the liver tissue by surgeons. Additionally, liver hardness was measured using a durometer. Correlation coefficients for durometer-measured hardness and preoperative parameters were calculated. Multiple linear regression models were constructed to select the best predictive durometer scale. Receiver operating characteristic (ROC) curves and univariate and multivariate analyses were used to calculate the best model’s prediction of PHLF and risk factors for PHLF, respectively. A separate validation cohort (n = 162) was used to evaluate the model.

The stiffness measured using 2D-SWE and palpation scale had good linear correlation with durometer-measured hardness (Pearson rank correlation coefficient 0.704 and 0.729, respectively, P < 0.001). The best model for the durometer scale (hardness scale model) was based on stiffness, hepatitis B virus surface antigen, and albumin level and had an R² value of 0.580. The area under the ROC for the durometer and hardness scale for PHLF prediction were 0.807 (P = 0.002) and 0.785 (P = 0.005), respectively. The optimal cutoff value of the durometer and hardness scale was 27.38 (sensitivity = 0.900, specificity = 0.660) and 27.87 (sensitivity = 0.700, specificity = 0.787), respectively. Patients with a hardness scale score of > 27.87 were at a significantly higher risk of PHLF with hazard ratios of 7.835 (P = 0.015). The model’s PHLF predictive ability was confirmed in the validation cohort.

Liver stiffness assessed by 2D-SWE and palpation correlated well with durometer hardness values. The multiple linear regression model predicted durometer hardness values and PHLF.

• Hepatectomy
• Liver Hardness
• Durometer
• Two-dimensional shear wave elastography
• Post-hepatectomy liver failure
• Liver failure

zhangchengwuzr@hotmail.com; Prof. Tian Yang, MD. Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai 200438, China. Email: yangtiandfgd@hotmail.com.

Identifying patients at high risks of developing postoperative morbidity is important to improve perioperative outcomes. We sought to define the accuracy of two objective and non-invasive serological-based scores, i.e., albumin-bilirubin (ALBI) and aspartate transaminase-to-platelet ratio index (APRI), to predict postoperative morbidity among patients undergoing hepatectomy for hepatocellular carcinoma (HCC), and build up a personalized predictive tool for clinical practice.

Clinical data of patients who underwent hepatectomy for HCC at 8 hospitals from a multicenter database were retrospectively analyzed. The predictive accuracy of ALBI and APRI relative to 30-day overall and major morbidity were evaluated using area under the receiver operating characteristic curves (AUC). Based on multivariable logistic regression analyses, preoperative and postoperative nomogram models and consequent online calculators were constructed to predict overall and major morbidity, respectively.

Among 2,301 patients, 725 (31.5%) experienced postoperative complications (major morbidity, 35.9%, 260/725). Multivariable analyses identified high ALBI grade (>−2.6) and APRI grade (>1.5) as independent risk factors associated with overall and major morbidity in both preoperative and postoperative prediction models. Two nomogram predictive models and corresponding online calculators that combined ALBI and APRI were subsequently constructed. The AUCs of the preoperative and postoperative models were 0.728 and 0.742 to predict overall morbidity, and 0.739 and 0.713 to predict major morbidity, respectively, which were much higher than those of Child-Pugh score and the model for end-stage liver disease (MELD). Using the bootstrap validation method, the resulting models were internally validated well.

Preoperative ALBI and APRI scores can predict postoperative morbidity following hepatectomy for HCC. An easy-to-use online calculator that combined ALBI and APRI was proposed for individually predicting the probabilities of postoperative overall and major morbidity before and immediately after surgery, so as to provide useful information to inform conversations about surgical risks.

• Albumin-bilirubin (ALBI)
• aspartate transaminase to platelet ratio index
• aspartate transaminase-to-platelet ratio index (APRI)
• hepatocellular carcinoma (HCC)
• morbidity

• Hepatitis B virals
• Hepatocellular carcinoma
• Nomogram
• Posthepatectomy liver failure

• Adolescent
• Adult
• Aged
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/virology
• Female
• Follow-Up Studies
• Hepatectomy/adverse effects
• Hepatitis B/complications
• Hepatitis B/pathology
• Hepatitis B/virology
• Hepatitis B virus
• Humans
• Liver Failure/diagnosis
• Liver Failure/etiology
• Liver Failure/pathology
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Liver Neoplasms/virology
• Male
• Middle Aged
• Nomograms
• Postoperative Complications/diagnosis
• Postoperative Complications/etiology
• Postoperative Complications/pathology
• Prognosis
• Prospective Studies
• Retrospective Studies
• Risk Factors
• Young Adult

• No:81803007 National Outstanding Youth Science Fund Project of National Natural Science Foundation of China
• No:2018GXNSFBA281030 National Outstanding Youth Science Fund Project of National Natural Science Foundation of China
• No:81730097 Natural Science Foundation of Qinghai (CN)
• No. 81521091 Science Fund for Creative Research Groups
• No:2015CB554000 Chang Jiang Scholars Programme (2013) of China Ministry of Education

Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging prognostic indicators in HCC.

To study published literature of NLR and ALBI over the last five years, and to validate NLR and ALBI locally in our centre as indicators of HCC survival.

A systematic review of the published literature on PubMed of NLR and ALBI in HCC over the last five years. The search followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses. Additionally, we also investigated HCC cases between December 2013 and December 2018 in our centre.

There were 54 studies describing the relation between HCC and NLR and 95 studies describing the relation between HCC and ALBI grade over the last five years. Our local cohort of patients showed NLR to have a significant negative relationship to survival (P = 0.011). There was also significant inverse relationship between the size of the largest HCC nodule and survival (P = 0.009). Median survival with alpha fetoprotein (AFP) < 10 KU/L was 20 mo and with AFP > 10 KU/L was 5 mo. We found that AFP was inversely related to survival, this relationship was not statically significant (P = 0.132). Mean survival for ALBI grade 1 was 37.7 mo, ALBI grade 2 was 13.4 months and ALBI grade 3 was 4.5 mo. ALBI grades performed better than Child Turcotte Pugh score in detecting death from HCC.

NLR and ALBI grade in HCC predict survival better than the conventional alpha fetoprotein. ALBI grade performs better than Child Turcotte Pugh score. These markers are done as part of routine clinical care and in cases of normal alpha fetoprotein, these markers could give a better understanding of the patient disease progression. NLR and ALBI grade could have a role in modified easier to learn staging and prognostic systems for HCC.

• Hepatocellular carcinoma
• Albumin bilirubin Grade
• Neutrophil to lymphocyte ratio
• Alpha fetoprotein
• Prognosis
• Survival

• Albumins
• Bilirubin
• Carcinoma, Hepatocellular
• Child
• Humans
• Liver Neoplasms
• Lymphocytes
• Neutrophils
• Prognosis
• Retrospective Studies

• Future liver remnant
• Major hepatectomy
• Portal vein embolization
• Post-hepatectomy liver failure

Testing for the presence of liver cirrhosis (LC) is one of the most critical diagnostic and prognostic assessments for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). More non-invasive tools are needed to diagnose LC but the predictive abilities of current models are still inconclusive. This study aimed to develop and validate a novel and non-invasive artificial neural network (ANN) model for diagnosing LC in patients with HBV-related HCC using routine laboratory serological indicators.

A total of 1152 HBV-related HCC patients who underwent hepatectomy were included and randomly divided into the training set (n = 864, 75%) and validation set (n = 288, 25%). The ANN model was constructed from the training set using multivariate Logistic regression analysis and then verified in the validation set.

The morbidity of LC in the training and validation sets was 41.2% and 46.8%, respectively. Multivariate analysis showed that age, platelet count, prothrombin time and total bilirubin were independent risk factors for LC (P < 0.05). The area under the ROC curve (AUC) analyses revealed that the ANN model had higher predictive accuracy than the Logistic model (ANN: 0.757 vs Logistic: 0.721; P < 0.001), and other scoring systems (ANN: 0.757 vs CP: 0.532, MELD: 0.594, ALBI: 0.575, APRI: 0.621, FIB-4: 0.644, AAR: 0.491, and GPR: 0.604; P < 0.05 for all) in diagnosing LC. Similar results were obtained in the validation set.

The ANN model has better diagnostic capabilities than other commonly used models and scoring systems in assessing LC risk in patients with HBV-related HCC.

• artificial neural network
• chronic hepatitis B
• hepatocellular carcinoma
• liver cirrhosis
• non-invasive assessment
• serological indicators

The aim of this study was to assess and compare the discriminatory performance of well-known risk assessment scores in predicting mortality risk after extended hepatectomy (EH). A series of 250 patients who underwent EH (≥5 segments resection) were evaluated. Aspartate aminotransferase-to-platelet ratio index (APRI), albumin to bilirubin (ALBI) grade, predictive score developed by Breitenstein et al., liver fibrosis (FIB-4) index, and Heidelberg reference lines charting were used to compute cut-off values, and the sensitivity and specificity of each risk assessment score for predicting mortality were also calculated. Major morbidity and 90-day mortality after EH increased with increasing risk scores. APRI (86%), ALBI (86%), Heidelberg score (81%), and FIB-4 index (79%) had the highest sensitivity for 90-day mortality. However, only the FIB-4 index and Heidelberg score had an acceptable specificity (70% and 65%, respectively). A two-stage risk assessment strategy (Heidelberg–FIB-4 model) with a sensitivity of 70% and a specificity 86% for 90-day mortality was proposed. There is no single specific risk assessment score for patients who undergo EH. A two-stage screening strategy using Heidelberg score and FIB-4 index was proposed to predict mortality after major liver resection.

• Hepatectomy
• Hepatitis B virus
• Hepatocellular carcinoma
• Model for end-stage liver disease
• Post-hepatectomy liver failure
• Standardized future liver remnant

Aspartate aminotransferase-to-platelet ratio index (APRI) is widely used in the assessment of fibrosis and cirrhosis, especially in patients with chronic hepatitis. However, the prognostic value of APRI in patients with chronic hepatitis with regard to the prediction of hepatocellular carcinoma (HCC) occurrence remains controversial. The objective of this meta-analysis is to investigate the association between APRI and HCC risk on the basis of cohort studies.

We systematically reviewed PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure databases for relevant cohort studies up to May 1, 2019. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) for total and subgroup analyses were calculated with Stata 12.0 software for the assessment of the relationship between APRI and HCC risk.

A total of 13 studies, involving 8897 patients, were included in the meta-analysis, of which 11 explored the association between pretreatment APRI and HCC risk and four reported the relationship between posttreatment APRI and HCC risk. Pooled results showed that an elevated level of pretreatment APRI was associated with increased HCC risk (HR = 2.56, 95% CI: 1.78–3.68). When stratified by hepatitis type, high pretreatment APRI predicted HCC development in patients with chronic hepatitis B (CHB) and C (CHC) but not in alcoholic liver cirrhosis (ALC). In the subgroup analyses of study region, cut-off value, sample size, and analysis method, the relationship between high pretreatment APRI and increased HCC risk was significant. Meanwhile, patients with a high level of posttreatment APRI suffered from high HCC risk (HR = 3.69, 95% CI: 2.52–5.42). Conclusion: Results revealed a significant association between elevated APRI and HCC development in patients with chronic hepatitis, suggesting that APRI might serve as a valuable predictor for HCC risk in patients with chronic hepatitis.

Post-hepatectomy liver failure (PHLF) is a severe complication in hepatocellular carcinoma (HCC) patients who have undergone hepatectomy. This research aimed to investigate the combination of albumin–bilirubin (ALBI) score and aspartate aminotransferase-platelet ratio index (APRI) as a novel approach in predicting PHLF risk in hepatitis B virus (HBV)-related HCC patients.

HBV-related HCC patients who underwent hepatectomy from January 2006 to October 2013 were enrolled in this study. A novel model was constructed using a combination of ALBI and APRI scores to predict PHLF risk, and the prognostic value of the model was evaluated and compared with Child-Pugh (C-P) grade, ALBI score and APRI score.

A total of 1,055 HCC patients were retrospectively studied, which included 151 experienced PHLF. Univariable and multivariate analyses showed that the ALBI and APRI scores were independent predictors of PHLF. The area under the ROC curve (AUC) of the ALBI score, APRI score, and C-P grade was 0.717, 0.720, and 0.602, respectively, with AUC (ALBI) > AUC (C-P) (P <0.001) and AUC (APRI) > AUC (C-P) (P <0.001). After ALBI was associated with APRI, the AUC (ALBI-APRI) was 0.766, and AUC (ALBI-APRI) > AUC (ALBI) (P <0.001), AUC (ALBI-APRI) > AUC (APRI) (P =0.047). Our results indicated that ALBI and APRI scores had higher discriminatory abilities than C-P grade in predicting the risk of PHLF, and the ALBI-APRI model could enhance the capability of predicting PHLF compared to ALBI or APRI alone.

ALBI-APRI score is a novel and effective predictive model of PHLF for HBV-related HCC patients, and its accuracy in predicting the risk of PHLF is better than that of C-P, ALBI and APRI scores.

• ALBI
• APRI
• HCC
• PHLF
• combination of ALBI and APRI