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Objective:To study the predictive value of Barcelona clinic liver cancer (BCLC) staging system combined with albumin-indocyanine green (ALICE) score (ALICE-BCLC) in hepatectomy for hepatocellular carcinoma, and compare it with BCLC staging system combined with Child-Pugh score (CP-BCLC).Methods:The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively. There were 271 males and 40 females, with a median age of 59 years old (range 26 to 92 years old). These patients were divided into two groups based on the ALICE-BCLC: the ALICE-BCLC grade 0 group ( n=63) and the ALICE-BCLC grade A group ( n=248); and another two groups based on the CP-BCLC: the CP-BCLC grade 0 group ( n=58) and the CP-BCLC grade A group ( n=253). The clinical data, including indocyanine green retention rate at 15 min, and albumin were collected and the scores were calculated. Follow-up was conducted by combining outpatient visits with telephone calls. The survival rate was calculated by the life method, and survival curves were drawn by the Kaplan-Meier method. The multivariate Cox regression model was used to determine the main factors affecting prognosis. Weighted Kappa was used to compare consistency of the two staging systems. Results:Multivariate analysis showed that a maximum tumor diameter >5 cm, total bilirubin >18 μmol/L, major hepatectomy, CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent (all P<0.05). The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months, respectively. There was a significant difference between the two groups ( P=0.017). The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months, respectively. There was a significant difference between the two groups ( P=0.035). The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949, showing a strong consistency ( P<0.001). Conclusion:ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection, and it had a similar overall prognostic discrimination ability as CP-BCLC.
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Objective:To investiagte the ability of albumin-indocyanine green (ALICE) score, albumin-bilirubin (ALBI) score and Child-Pugh score in predicting postoperative liver failure (PHLF) in patients with hepatocellular carcinoma, and to determine the clinical value of ALICE score.Methods:The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery, Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed, including 350 males and 47 females, aged (58.9±11.2) years. Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF. The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic (ROC) curve, and compared with ALBI score and Child-Pugh score.Results:There were 74 patients with PHLF and 323 patients without PHLF. Multivariate logistic regression analysis showed that Child-Pugh score ( OR=1.630, 95% CI: 1.251-2.486, P=0.034), ALBI score ( OR=1.863, 95% CI: 1.028-3.119, P=0.049) and ALICE score ( OR=1.759, 95% CI: 1.216-3.078, P=0.038) were independent risk factors for PHLF in patients with hepatocellular carcinoma, and the risk of PHLF increased with the increase of grade. The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613 (95% CI: 0.564-0.662), the area under the ALBI score was 0.612 (95% CI: 0.563-0.661), and the area under the Child-Pugh score was 0.555 (95% CI: 0.505-0.605). The ALICE score was better than the Child-Pugh score, and the difference was statistically significant ( z=2.04, P=0.041). In small liver resection patients, ALICE score was better than Child-Pugh score ( z=2.61, P=0.009). There was no significant difference betwenn ALICE score and ALBI score ( z=0.06, P=0.954). Conclusion:ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma, especially in patients with small liver resection, its value is similar to ALBI score, but better than Child-Pugh score.