Platelet-albumin (PAL) score as a predictor of perioperative outcomes and survival in patients with hepatocellular carcinoma undergoing liver resection in a Western center. (June 2022)

• Record Type: Journal Article
• Authors: Meira Júnior, José Donizeti de; Fonseca, Gilton Marques; Carvalho Neto, Francisco Nolasco de; Jeismann, Vagner Birk; Kruger, Jaime Arthur Pirola; Silva, João Paulo Maciel; Coelho, Fabricio Ferreira; Herman, Paulo
• Is Part Of: Surgical oncology. Volume 42(2022)
• Publication Date: 2022-06
• Subjects: Hepatectomy -- Morbidity -- Mortality -- Survival -- Liver failure; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2022.101752
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: 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. Highlights: In Western countries, most hepatocellular carcinomas develop in cirrhotic livers. Preoperative selection of patients who will benefit from resection is challenging. Main prognostic factors are accessible only after pathological evaluation. Platelet-Albumin score is a widely available preoperative prognostic tool. Platelet-Albumin score correlates with morbidity, mortality, and survival.