Suchergebnisse

Cheng-Cheng Zhang1 ,* Cheng-Wu Zhang2 ,* Hao Xing3 ,* Yu Wang4 ,* Lei Liang2,5 ,* Yong-Kang Diao2,5 ,* Ting-Hao Chen,6 Wan Yee Lau,3,7 Ping Bie,8 Zhi-Yu Chen,1 Tian Yang1,3 1Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China; 2Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China; 3Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China; 4Department of Hepatobiliary Surgery, Chongqing University Cancer Hospital, Chongqing, China; 5Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, China; 6Department of General Surgery, Ziyang First People's Hospital, Sichuan, China; 7Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; 8Department of Hepatobiliary, The Third Affiliated Hospital, Chongqing Medical University, Chongqing, China*These authors contributed equally to this workCorrespondence: Zhi-Yu ChenDepartment of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), No. 30, Gaotanyan Street, Chongqing 400038, ChinaEmail chenzhiyu_umn@163.comTian YangDepartment of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), No. 225, Changhai Road, Shanghai 200438, ChinaEmail yangtian6666@hotmail.comBackground: A normal albumin-to-globulin ratio (NAGR) in serum is greater than 1. Inversed albumin-to-globulin ratio (IAGR < 1) indicates poor synthetic liver function or malnutrition. The aim of this study is to evaluate whether preoperative IAGR was associated with worse oncologic survival after hepatectomy for hepatocellular carcinoma (HCC).Patients and Methods: Patients who underwent curative hepatectomy for HCC between 2009 and 2016 in four centers were divided into the IAGR and NAGR groups based on their preoperative levels, and their clinical characteristics and long-term survival outcomes were compared. Univariable and multivariable Cox regression analyses were performed to identify risk factors of overall survival (OS) and recurrence-free survival (RFS).Results: Of 693 enrolled patients, 136 (19.6%) were in the IAGR group. Their 5-year OS and RFS rates were 31.6% and 21.3%, respectively, which were significantly worse than the NAGR group (43.4% and 28.7%, both P < 0.001). The area under the receiver operating characteristic curves in predicting 5-year OS and RFS using the albumin-to-globulin ratio were 0.68 and 0.67, respectively, which were significantly higher than albumin (0.60 and 0.59), globulin (0.56 and 0.57), Child-Pugh grading (0.61 and 0.60), Model for End-Stage Liver Disease Score (0.59 and 0.58), and Albumin-Bilirubin grading (0.64 and 0.63). Multivariable analyses identified that preoperative IAGR was independently associated with worse OS (HR: 1.444, 95% confidence interval (CI): 1.125– 1.854, P = 0.004) and RFS (HR: 1.463, 95% CI: 1.159– 1.848, P = 0.001).Conclusion: Preoperative IAGR was useful in predicting worse OS and RFS in patients who underwent curative hepatectomy for HCC.Keywords: hepatocellular carcinoma, hepatectomy, albumin, globulin, survival, recurrence