RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma

BMC Cancer

Research Article

Shu-Wei Huang¹  Wen-Juei Jeng¹  Cheng-Yu Lin¹  Chun-Wei Chen¹  Heng-Yuan Hsu²  Wei-Chen Lee²  Ming-Chin Yu³  Miin-Fu Chen³  Chao-Wei Lee⁴  Hsin-I Tsai⁵  Chang-Mu Sung⁶ 

[1] Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., 333, Taoyuan, Taiwan, Republic of China;Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., 333, Taoyuan, Taiwan, Republic of China;Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., 333, Taoyuan, Taiwan, Republic of China;College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China;Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., 333, Taoyuan, Taiwan, Republic of China;College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China;Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China;Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China;Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., 333, Taoyuan, Taiwan, Republic of China;Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China;Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., 333, Taoyuan, Taiwan, Republic of China;

关键词: Early mortality;    Early recurrence;    Short term outcome;    Hepatectomy;    Liver resection;    Hepatocellular carcinoma;    Hepatoma;    RAM score;   

DOI  :  10.1186/s12885-017-3748-9

 received in 2017-02-23, accepted in 2017-11-01,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundLiver resection had been regarded as a standard treatment for primary hepatocellular carcinoma (HCC). However, early mortality and recurrence after surgery were still of major concern. RAM (Risk Assessment for early Mortality) scoring system is a newly developed tool for assessing early mortality after hepatectomy for HCC. In this study, we compared RAM scoring system with ALBI and MELD scores for their capability of predicting short-term outcome.MethodsWe retrospectively reviewed patients with hepatocellular carcinoma who were treated with hepatectomy at Chang Gung Memorial Hospital between 1986 and 2015. Their clinical characteristics and perioperative variables were collected. We applied RAM, albumin-bilirubin (ALBI), and model for end-stage liver disease (MELD) scoring systems to predict early mortality and early recurrence in HCC patients after surgery. We investigated the discriminative power of each scoring system by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC).ResultsA total of 1935 patients (78% male) who underwent liver resection for HCC were included in this study. The median follow-up period was 41.9 months. One hundred and forty-nine patients (7.7%) died within 6 months after hepatectomy (early mortality). All the three scoring systems were effective predictor for early mortality, with higher score indicating higher risk of early mortality (AUC of RAM = 0.723, p < 0.001; AUC of ALBI = 0.682, p < 0.001; AUC of MELD = 0.590, p = 0.002). Cox regression multivariate analysis demonstrated that the RAM class was the most significant independent predictor of early mortality after surgery, while MELD grade failed to discriminatively predict early mortality. In addition to early mortality, the RAM score was also predictive of early recurrence in HCC after surgery.ConclusionsThis study demonstrated that RAM score is an effective and user-friendly bedside scoring system to predict early mortality and early recurrence after hepatectomy for HCC. In addition, the predictive capability of RAM score is superior to ALBI and MELD scores. Further study is warranted to validate our findings.

【 授权许可】

CC BY   
© The Author(s). 2017