Novel Risk Score Incorporating Type-IV Collagen, Albumin, and Prothrombin Time (CAP score) to Predict 180-Day Surgery-Related Mortality After Liver Resection for Hepatocellular Carcinoma

Abstract

Background: Accurate preoperative risk assessment is crucial for patients undergoing liver resection for hepatocellular carcinoma (HCC). The present study developed and validated a novel scoring system for predicting 180-day surgery-related mortality.

Patients and methods: This retrospective cohort study enrolled patients who underwent liver resection for HCC between 2000 and 2024. The cohort was divided into training and validation sets on the basis of the operation dates. Multivariate analysis was performed to identify the independent predictors of 180-day surgery-related mortality. The resulting score was compared with the existing models.

Results: Three independent predictors were identified and assigned one point each: type-IV collagen ≥ 7.5 ng/mL (odds ratio [OR]: 2.92; 95% confidence interval [CI] 1.20-7.65; P = 0.017), albumin (Alb) ≤ 3.4 g/dL (OR: 3.06, 95% CI 1.23-8.39; P = 0.016), and prothrombin time-international normalized ratio (PT-INR) ≥ 1.26 (OR: 2.82; 95% CI 1.14-6.70; P = 0.026). The 180-day surgery-related mortality rates for the low- (0 point), intermediate- (1-2 points), and high-risk (3 points) groups were 0.8%, 7.6%, and 26.7%, respectively, in the training cohort, and 1.7%, 6.5%, and 20.7%, respectively, in the validation cohort. The collagen-Alb-PT-INR (CAP) score demonstrated superior predictive performance (area under the curve [AUC]: 0.728) as compared with the stratified Model for End-Stage Liver Disease score (AUC: 0.557, P < 0.001), the Child-Pugh classification (AUC: 0.637, P < 0.001), and the Alb-bilirubin grade (AUC: 0.668, P = 0.014).

Conclusions: The CAP score is a simple and effective tool for predicting 180-day surgery-related mortality post-liver resection for HCC.

Keywords: Albumin; Hepatocellular carcinoma; Liver resection; Prothrombin time-international normalized ratio; Surgery-related death; Type IV collagen.

Fig. 1

Comparison of 180-day surgery-related mortality rates and odds ratios among the risk groups (low-, intermediate-, and high-risk groups) in the training, validation, and total cohorts based on the collagen–Alb–PT-INR classification system

Fig. 2

Comparison of receiver operating characteristic curves for predicting 180-day surgery-related mortality: collagen–Alb–PT-INR classification versus conventional liver function scoring systems (MELD, Child–Pugh, and ALBI)