K. Haruki1, H. Shiba1, N. Saito1, T. Horiuchi1, Y. Shirai1, Y. Fujiwara1, K. Furukawa1, T. Sakamoto1, T. Gocho1, T. Misawa1, K. Yanaga1 1The Jikei University School Of Medicine,Department Of Surgery,Tokyo, TOKYO, Japan
Introduction: Liver function in patients with hepatocellular carcinoma (HCC) is generally graded according to the Child-Pugh (C-P) system. However, some variables in the C-P grade are subjective. We developed a novel objective score; prothrombin time-international normalized ratio to albumin ratio (PTAR). The aim of this study is to evaluate the prognostic value of PTAR in patients with HCC after hepatic resection.
Methods: The study comprised 199 patients who had undergone elective hepatic resection for HCC between January 2003 and December 2014. We retrospectively investigated the relation between PTAR and disease-free as well as overall survival and assessed hepatic functional reserve using the PTAR in comparison with C-P grade.
Results: The optimal cut-off level of the PTAR was 0.288. In multivariate analysis, the independent and significant predictors of cancer recurrence consisted of HCV infection (p=0.011), pT4 or pT3 (p<0.001) and PTAR ≥ 0.0288 (p=0.024), while the independent and significant predictors of poor overall survival were pT4 or pT3 (p<0.001) and PTAR ≥ 0.0288 (p<0.001). ICGR15 (p=0.007), C-P score (p<0.001) and serum AFP (p=0.037) positively correlated with high PTAR. Pathological liver cirrhosis (p<0.001), postoperative ascites (p=0.039) and postoperative liver failure (p=0.040) in patients with high PTAR were significantly greater than their counterparts. In patients with C-P grade A, PTAR ≥ 0.0288 was significantly associated with worse disease-free survival (p=0.024) and overall survival (p=0.030).
Conclusion: The PTAR may be an independent and significant indicator of poor long-term outcome in patients with HCC after hepatic resection. The PTAR may reflect liver function, and patients with C-P grade A could be stratified by the PTAR.