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Assessment of Preoperative Liver Function in Patients with Hepatocellular Carcinoma - The Albumin-Indocyanine Green Evaluation (ALICE) Grade.
Kokudo, Takashi; Hasegawa, Kiyoshi; Amikura, Katsumi; Uldry, Emilie; Shirata, Chikara; Yamaguchi, Takamune; Arita, Junichi; Kaneko, Junichi; Akamatsu, Nobuhisa; Sakamoto, Yoshihiro; Takahashi, Amane; Sakamoto, Hirohiko; Makuuchi, Masatoshi; Matsuyama, Yutaka; Demartines, Nicolas; Malagó, Massimo; Kokudo, Norihiro; Halkic, Nermin.
Affiliation
  • Kokudo T; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Hasegawa K; Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
  • Amikura K; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Uldry E; Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
  • Shirata C; Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
  • Yamaguchi T; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Arita J; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Kaneko J; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Akamatsu N; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Sakamoto Y; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Takahashi A; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  • Sakamoto H; Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
  • Makuuchi M; Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
  • Matsuyama Y; Division of Hepato-Billiary-Pancreatic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
  • Demartines N; Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan.
  • Malagó M; Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
  • Kokudo N; Department of Surgery-UCL Division of Surgical and Interventional Sciences, University College London, London, United Kingdom.
  • Halkic N; Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
PLoS One ; 11(7): e0159530, 2016.
Article in En | MEDLINE | ID: mdl-27434062
ABSTRACT

BACKGROUND:

Most patients with hepatocellular carcinoma (HCC) have underlying liver disease, therefore, precise preoperative evaluation of the patient's liver function is essential for surgical decision making.

METHODS:

We developed a grading system incorporating only two variables, namely, the serum albumin level and the indocyanine green retention rate at 15 minutes (ICG R15), to assess the preoperative liver function, based on the overall survival of 1868 patients with HCC who underwent liver resection. We then tested the model in a European cohort (n = 70) and analyzed the predictive power for the postoperative short-term outcome.

RESULTS:

The Albumin-Indocyanine Green Evaluation (ALICE) grading system was developed in a randomly assigned training cohort linear predictor = 0.663 × log10ICG R15 (%)-0.0718 × albumin (g/L) (cut-off value -2.20 and -1.39). This new grading system showed a predictive power for the overall survival similar to the Child-Pugh grading system in the validation cohort. Determination of the ALICE grade in Child-Pugh A patients allowed further stratification of the postoperative prognosis. This result was reproducible in the European cohort. Determination of the ALICE grade allowed better prediction of the risk of postoperative liver failure and mortality (ascites grade 1, 2.1%; grade 2, 6.5%; grade 3, 16.0%; mortality grade 1, 0%; grade 2, 1.3%; grade 3, 5.3%) than the previously reported model based on the presence/absence of portal hypertension.

CONCLUSIONS:

This new grading system is a simple method for prediction of the postoperative long-term and short-term outcomes.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Serum Albumin / Carcinoma, Hepatocellular / Hepatectomy / Indocyanine Green / Liver Neoplasms Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2016 Document type: Article Affiliation country: Japan

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Serum Albumin / Carcinoma, Hepatocellular / Hepatectomy / Indocyanine Green / Liver Neoplasms Type of study: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: PLoS One Journal subject: CIENCIA / MEDICINA Year: 2016 Document type: Article Affiliation country: Japan