Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):440-450. 10.14701/ahbps.24-110.

Construction and validation of a preoperative prognostic model integrating the novel aspartate aminotransferasealbumin score for hepatocellular carcinoma patients undergoing liver resection

• Ikuta S
• Aihara T
• Kasai M
• Nakajima T
• Yamanaka N

• KMID: 2561576
• DOI: http://doi.org/10.14701/ahbps.24-110

Abstract

Backgrounds/Aims
Patients undergoing liver resection for hepatocellular carcinoma (HCC) often possess good liver reserve, which may limit the prognostic effectiveness of existing liver function scores. This study aimed to develop a novel liver function score and a preoperative prognostic model specifically for HCC resection patients.
Methods
Eight hundred twenty-seven HCC patients undergoing initial liver resection were segregated into training and validation cohorts in a 6:4 ratio. Cox regression analysis was employed to identify significant parameters influencing overall survival. The efficacy of the liver function score and prognostic model was evaluated using metrics such as the area under the receiver operating characteristic curve.
Results
Aspartate aminotransferase (AST) and albumin emerged as significant prognostic indicators. The AST-albumin (ASAL) score, calculated as exp [AST (IU/L) × 0.005 – albumin (g/dL) × 1.043] × 100, outperformed existing scores such as Child-TurcottePugh, albumin-bilirubin, platelet-albumin, and AST-platelet ratio index in both training and validation cohorts. Additionally, a scoring model that combined the ASAL score with alpha-fetoprotein and the up-to-seven criterion exhibited superior discriminatory capabilities compared to the American Joint Committee on Cancer tumor, node, metastasis stage, and Barcelona Clinic Liver Cancer stage.
Conclusions
The proposed prognostic model that integrates the novel ASAL score offers promising prognostic potential for HCC patients undergoing liver resection.

Keyword

Carcinoma, hepatocellular; Hepatectomy; Barcelona clinic liver cancer; Up-to-seven criterion

Figure

• 

  Fig. 1 Time-dependent area under the receiver operating characteristic curve analysis for overall survival estimation in the training (A, C) and validation (B, D) cohorts. AUC, area under the receiver operating characteristic curve; ASAL, aspartate aminotransferase-albumin; ALBI, albumin-bilirubin; PAL, platelet-albumin; CTP, Child-Turcotte-Pugh; APRI, aspartate aminotransferase-platelet ratio index; TNM, American Joint Committee on Cancer tumor, node, metastasis; BCLC, Barcelona Clinic Liver Cancer.

• 

  Fig. 2 Kaplan-Meier estimates of overall survival according to the ASAL score and prognostic model: (A) ASAL score in the training cohort, (B) ASAL score in the validation cohort, (C) prognostic model in the training cohort, (D) prognostic model in the validation cohort, (E) prognostic model limited to treatment-naive patients in the training cohort, and (F) prognostic model limited to treatment-naive patients in the validation cohort. ASAL, aspartate aminotransferase-albumin.

• 

  Fig. 3 Forest plot of subgroup analysis revealing the association between high ASAL score and overall survival across training and validation cohorts. Hazard ratios were adjusted for age, sex, hepatitis B virus antigen S status, anti-hepatitis C virus antibody status, largest tumor size, tumor count, and alpha-fetoprotein levels. ASAL, aspartate aminotransferase-albumin; CI, confidence interval; BCLC, Barcelona Clinic Liver Cancer; TNM, American Joint Committee on Cancer tumor, node, metastasis.

Reference

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