Pre-operation Nutritional Risk Assessment And Prognosis In Patients With Hepatocellular Carcinoma

ObjectiveUsing varience of nutritional assessment methods to screen preoperativenutritional risk of patients undergoing hepatectomy for primary HepatocytesCarcinoma, to understand the preoperative nutritional status of patients with primaryhepatocellular carcinoma and analyzes the influencing factors; To understandpostoperative survival condition of patients with primary hepatocellular carcinomaand analyzes the preoperative clinical relative factors on prognosis, to provide atheoretical basis for clinical practice.MethodThe713patients undergoing hepatectomy for primary Hepatocytes Carcinoma(HCC) in the cancer hospital of Zhengzhou university during1st, December2008to1stDecember,2012were followed up. European nutritional Risk Screening(NRS-2002) and Nutritional Risk Index (NRI) were used to screen the patients withmalnutrition. At the same time, the prognosis and survival condition of these patientswere recored. Kaplan-Meier analysis was used to draw survival curve of patientsfrom different clinical stages and different nutritional degree. Log-rank test was usedto compare the difference of the overall survival curve. And the postoperativesurvival time and baseline factors associated with HCC were analyzed by Coxregression. The testing level=0.05, statistical analysis was performed by usingSPSS21.0.Results(1) The analysis included713patients undergoing primary hepatocellularcarcinoma.98patients were lost to follow-up,615patients were followed upsuccessfully, the follow-up rate was86.26%. According to NRS-2002,261patients(42.44%) were at the risk of malnutrition,354patients (57.56%) had no risk ofmalnutrition. According to the NRI: There were19(3.19%) patients being at highnutritional risk (NRI<83.5),174(28.29%) patients being at medium nutritional risk (NRI83.5to≤97.5),63(10.24%) patients being at low nutritional risk (NRI97.5to≤100),359(58.37%) patients being at no nutritional risk (NRI>100). The resultsshowed that NRS-2002sensitivity, specificity, Youden index were79.12%,36.03%,0.15; NRI sensitivity, specificity, Youden index were100%,30.83%,0.15.(2) The media follow-up survival time was20months, with a cumulativesurvival probability of the615patients at1,2, and5years:49.94%,41.09%and16.02%respectively. The media follow-up survival time was38.44months, with acumulative survival probability of the no nutritional risk patients at1,2, and5years:59.12%,51.89%and27.54%respectively. The media follow-up survival time was13.33months, with a cumulative survival probability of the had nutritional riskpatients at1,2, and5years:36.70%,26.21%and6.03%respectively. Multivariateanalysis showed that albumin, lymphocyte count and Barcelona clinical liver cancerstaging were the risk factors of nutritional risk index.(3) Kaplan-Meier survival analysis and univariate log-rank test showed that thescores of NRS-2002, nutritional risk index (NRI), tumor size, tumor number, totalbilirubin, preoperative alpha-fetoprotein, aspartate aminotransferase, alanineaminotransferase/aspartate aminotransferase, alkaline phosphatase, glutamylendopeptidase, serum albumin, lymphocyte count, Child-pugh grading andBarcelona clinical liver cancer staging were significantly associated with thesurvival rates of patients undergoing hepatectomy for primary HepatocytesCarcinoma. Multivariate analysis (Cox regression) showed that tumor size, numberof tumors, preoperative alpha-fetoprotein, alkaline phosphatase, lymphocyte count,and the nutritional risk index were independent risk factors affecting postoperativesurvival time of patients with primary hepatocellular carcinoma.Conclusions(1) The incidence of preoperative malnutrition for patients with primaryhepatocellular carcinoma is high. Different nutritional risk screening methods for theevaluation of patients with primary hepatocellular carcinoma had inconsistent results,NRI is more suitable for screening the risk of preoperative malnutrition in patientswith HCC.(2) Preoperative malnutrition influenced the prognostic of patients with primary hepatocellular carcinoma, the patients without preoperativemalnutrition survived longer than those with preoperative malnutrition. Thenutritional risk index of patients undergoing HCC was related to albumin,lymphocyte count and Barcelona clinical liver cancer staging.(3) A variety of factors affected the prognosis of patients with hepatocellularcarcinoma, tumor diameter, the number of tumors, preoperative alphafetoprotein, alkaline phosphatase, lymphocyte count and nutritional risk index maybe independent factors affecting postoperative survival time of patientswith primary hepatocellular carcinoma.