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. 2022 Jul;52(7):1096-1108.
doi: 10.1007/s00595-021-02440-0. Epub 2022 Jan 23.

A novel combined prognostic nutritional index and aspartate aminotransferase-to-platelet ratio index-based score can predict the survival of patients with hepatocellular carcinoma who undergo hepatic resection

Kyohei Yugawa  1 , Takashi Maeda  2 , Shigeyuki Nagata  1 , Akihiro Sakai  1 , Makoto Edagawa  1 , Takahiro Omine  1 , Takuro Kometani  1 , Shohei Yamaguchi  1 , Kozo Konishi  1 , Kenkichi Hashimoto  1
Affiliations

A novel combined prognostic nutritional index and aspartate aminotransferase-to-platelet ratio index-based score can predict the survival of patients with hepatocellular carcinoma who undergo hepatic resection

Kyohei Yugawa et al. Surg Today. 2022 Jul.

Abstract

Purpose: Inflammation-, nutrition-, and liver fibrosis-related markers are recognized as prognostic for hepatocellular carcinoma (HCC) patients. This study, therefore, assessed the preoperative prognostic utility of the combination of these markers in patients with HCC.

Methods: This single-center retrospective study included patients who underwent hepatic resection for HCC between 2004 and 2017. A total of 454 patients were divided into training (n = 334) and validation (n = 120) cohorts by random sampling. The predictive impact on surgical outcomes was evaluated using receiver operating characteristic (ROC) curves of these prognostic values in the training cohort.

Results: The prognostic nutritional index (PNI) and aspartate aminotransferase-to-platelet ratio index (APRI) were the strongest diagnostic values (areas under the ROC curves: 0.627 and 0.646, respectively). A scoring system (over 0-2 points) was developed using optimal cutoff values (for PNI < 46.5 scored as 1 point; for APRI > 0.98 scored as 1 point). An increased PNI-APRI score was an independent prognostic factor for both the overall and disease-free survival in HCC patients. Finally, the clinical feasibility of the PNI-APRI score was confirmed in the validation cohort.

Conclusions: The PNI-APRI score is a useful marker for predicting surgical outcomes of HCC patients.

Keywords: Aspartate aminotransferase-to-platelet ratio index; Hepatocellular carcinoma; Prognosis; Prognostic nutritional index.

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