Integration of Prealbumin into Child-Pugh Classification Improves Prognosis Predicting Accuracy in HCC Patients Considering Curative Surgery

Background and Aims:The poor outcomes of hepatocellular carcinoma(HCC)patients may be due to not only malignant tumors but also limited liver function.Therefore,as stated in major guidelines,only patients with relatively normal liver function(Child-Pugh A)would be referred for curative hepatectomy.Even so,the postsurgery survival rate of patients is still extremely poor.Direct curative resection may benefit most patients.This study aimed to improve the prognosis predicting accuracy of the Child-Pugh scoring system.Methods:This study included two cohorts:cohort A being composed of 613 HCC patients,with a 23-month median postsurgery follow-up time;and cohort B being composed of 554 tumor-free chronic liver disease patients.Kaplan-Meier test and Cox model were used for survival analysis.Independent-samples t test or one-way ANOVA was used to test the differences between different groups.Results:Serum prealbumin levels were found inversely correlated with worsening of flbrotic scores(r=-0.482,p<0.001).Lower levels of presurgery prealbumin was an independent factor of poor postsurgery prognosis in Child-Pugh A patients,with a hazard ratio of 0.731(p=0.001).By integrating prealbumin together with total bilirubin level,serum albumin concentration and prothrombin time,a modified liver disease prognosis scoring system was developed to define traditional Child-Pugh A HCC patients as Modified Child-Pugh MCP-1,MCP-2 and MCP-3,with median postsurgery overall survival times of 44.00,28.00 and 11.00 months respectively.Conclusions:Preoperative serum prealbumin is a valuable prognosis predicting biomarker for Child-Pugh A HCC patients who may be under consideration for curative resection.With serum prealbumin included as one of the parameters,the MCP scoring system might improve the postsurgery survival predicting accuracy for HCC patients.

Hepatocellular Carcinoma Surveillance and Treatment:A Way to Reduce Cancer-related Mortality in Cirrhotic Patients

In the issue of Gastroenterology published October 2018,the article by Moon et al.1 demonstrated that screening patients with cirrhosis for hepatocellular carcinoma(HCC)by ultrasound scan(USS),measurement of serumα-fetoprotein(AFP),each alone or in combination,was not associated with the decreased HCC-related mortality.In this matched case control study,all the study patients were registered in detail in the U.S.Department of Veterans Affairs.The study included 238 cases who died of HCC with cirrhosis,and the same number of matched controls with cirrhosis who had been enrolled in U.S.Department of Veterans Affairs care for the 4 years before the index date and alive at the time of their matched case's death.The study retrospectively collected each case's USS and AFP screening data for 4 years before the date of HCC diagnosis or the equivalent index date in controls.Authors found that there was no significant difference of frequency of routine screening between the cases and controls.Therefore,the authors interpreted these results as indicating that the routine screening would not reduce cancer-related mortality.