Risk stratification using a novel liver functional reserve score of combination prothrombin time–international normalized ratio to albumin ratio and albumin in patients with hepatocellular carcinoma

Background: Liver function in patients with hepatocellular carcinoma is generally graded according to the Child-Pugh system; however, some variables in the Child-Pugh grade are subjective. We developed a novel, objective score called the prothrombin time–international normalized ratio to albumin ratio. The aim of this study was to evaluate the prognostic value of this new score in patients with hepatocellular carcinoma after hepatic resection. Methods: The study comprised 199 patients who underwent elective hepatic resection for hepatocellular carcinoma between January 2003 and December 2014. We investigated retrospectively the relation between prothrombin time–international normalized ratio to albumin ratio, disease-free survival, and overall survival and compared the value of liver functional reserve between prothrombin time–international normalized ratio to albumin ratio and Child-Pugh grade. Results: The optimal cut-off level of the prothrombin time–international normalized ratio to albumin ratio was 0.288. In multivariate analysis, the independent and significant predictors of cancer recurrence consisted of hepatitis C virus infection (P =.043), preoperative retention rate of indocyanine green at 15 minutes ≥15% (P =.039), the presence of multiple tumors (P =.001) or microvascular invasion (P <.001), and prothrombin time–international normalized ratio to albumin ratio ≥0.288 (P =.022). The independent predictors of poor overall survival were microvascular invasion (P =.001) and prothrombin time–international normalized ratio to albumin ratio ≥0.288 (P =.001). In patients with a high prothrombin time–international normalized ratio to albumin ratio, pathologic liver cirrhosis (P <.001), postoperative ascites (P =.039), and postoperative liver failure (P =.040) were greater than for their counterparts. Conclusion: The prothrombin time–international normalized ratio to albumin ratio may reflect liver function and may be a novel indicator of poor long-term outcome in patients with hepatocellular carcinoma after hepatic resection.