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. 2025 Jun 23.
doi: 10.1245/s10434-025-17658-2. Online ahead of print.

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

Tomoaki Hayakawa  1 , Shotaro Miyashita  1 , Maiko Niki  1 , Genki Tanaka  1 , Takayuki Shimizu  1 , Takamune Yamaguchi  1 , Kyung-Hwa Park  1 , Takatsugu Matsumoto  1 , Takayuki Shiraki  1 , Shozo Mori  1 , Taku Aoki  2
Affiliations

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

Tomoaki Hayakawa et al. Ann Surg Oncol. .

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.

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Conflict of interest statement

Disclosure: Nothing to report.

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