Platelet-albumin (PAL) score as a predictor of perioperative outcomes and survival in patients with hepatocellular carcinoma undergoing liver resection in a Western center.

BACKGROUND AND OBJECTIVES: Preoperative selection of patients with hepatocellular carcinoma (HCC) who will benefit from resection is highly advisable. The Platelet-Albumin (PAL) score was developed as a predictor of survival and morbidity following HCC resection. However, this has never been tested in western populations. METHODS: The impact of PAL score on perioperative outcomes and survival was evaluated and compared to Child-Pugh, Model for End-Stage Liver Disease (MELD), and albumin-bilirubin (ALBI) scores in patients who underwent HCC resection. RESULTS: A total of 182 patients were included. Postoperative morbidity was higher in patients with PAL grade II-III (P = 0.039), ALBI grade II-III (P = 0.028), and MELD >10 (P = 0.042). Post-hepatectomy liver failure (PHLF) occurred in 36 patients (19.8%) and was significantly higher in the PAL II-III and ALBI score II-III subgroup (P = 0.001). The PAL II-III group was the only one associated with higher perioperative mortality (OR 3.3, P = 0.036). The PAL score was an independent prognostic factor for overall survival in multivariate analysis (P = 0.018) and was the only one with the areas under the curve in ROC analysis significantly different for morbidity, PHLF, and mortality. CONCLUSIONS: The PAL score predicts postoperative complications, mortality, PHLF, and survival following liver resection for HCC in western patients.