Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

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

Authors: Heng-Yuan Hsu, Ming-Chin Yu, Chao-Wei Lee, Hsin-I Tsai, Chang-Mu Sung, Chun-Wei Chen, Shu-Wei Huang, Cheng-Yu Lin, Wen-Juei Jeng, Wei-Chen Lee, Miin-Fu Chen

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

Liver 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.

Methods

We 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).

Results

A 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.

Conclusions

This 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.
Literature
1.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefPubMed
2.
Department of Health, ROC. Report of leading cancer-related death in 2014. Department of health, Executive Yuan, Rebpulic of China 2015.
3.
Wei AC, Tung-Ping Poon R, Fan ST, Wong J. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg. 2003;90(1):33–41.CrossRefPubMed
4.
Gozzetti G, Mazziotti A, Cavallari A, Bellusci R, Bolondi L, Grigioni W, et al. Clinical experience with hepatic resections for hepatocellular carcinoma in patients with cirrhosis. Surg Gynecol Obstet. 1988;166(6):503–10.PubMed
5.
Bismuth H, Houssin D, Ornowski J, Meriggi F. Liver resections in cirrhotic patients: a western experience. World J Surg. 1986;10(2):311–7.CrossRefPubMed
6.
7.
Fortner JG, Kim DK, Maclean BJ, Barrett MK, Iwatsuki S, Turnbull AD, et al. Major hepatic resection for neoplasia: personal experience in 108 patients. Ann Surg. 1978;188(3):363–71.CrossRefPubMedPubMedCentral
8.
9.
Lai EC, Fan ST, Lo CM, Chu KM, Liu CL, Wong J. Hepatic resection for hepatocellular carcinoma. An audit of 343 patients. Ann Surg. 1995;221(3):291–8.CrossRefPubMedPubMedCentral
10.
Matsumata T, Kanematsu T, Shirabe K, Sonoda T, Furuta T, Sugimachi K. Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma. Br J Surg. 1990;77(6):677–80.CrossRefPubMed
11.
Lin HM, Lei LM, Zhu J, Li GL, Min J. Risk factor analysis of perioperative mortality after ruptured bleeding in hepatocellular carcinoma. World J Gastroenterol. 2014;20(40):14921–6.CrossRefPubMedPubMedCentral
12.
Yang T, Zhang J, JH L, Yang GS, MC W, Risk YWF. Factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg. 2011;35(9):2073–82.CrossRefPubMed
13.
Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg. 1999;229(3):322–30.CrossRefPubMedPubMedCentral
14.
Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Jeng WJ, et al. Risk factors for early mortality after hepatectomy for hepatocellular carcinoma. Medicine (Baltimore). 2016;95(39):e5028.CrossRef
15.
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PCA. Model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–71.CrossRefPubMed
16.
Ross SW, Seshadri R, Walters AL, Augenstein VA, Heniford BT, Iannitti DA, et al. Mortality in hepatectomy: model for end-stage liver disease as a predictor of death using the National Surgical Quality Improvement Program database. Surgery. 2016;159(3):777–92.CrossRefPubMed
17.
Delis SG, Bakoyiannis A, Dervenis C, Tassopoulos N. Perioperative risk assessment for hepatocellular carcinoma by using the MELD score. J Gastrointest Surg. 2009;13(12):2268–75.CrossRefPubMed
18.
Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford). 2009;11(4):351–7.CrossRef
19.
Andreatos N, Amini N, Gani F, Margonis GA, Sasaki K, Thompson VM, et al. Albumin-bilirubin score: predicting short-term outcomes including bile leak and post-hepatectomy liver failure following hepatic resection. J Gastrointest Surg. 2017;21(2):238–48.CrossRefPubMed
20.
Zou D, Qi X, Zhu C, Ning Z, Hou F, Zhao J, et al. Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: a retrospective study. Turk J Gastroenterol. 2016;27(2):180–6.CrossRefPubMed
21.
Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33(6):550–8.CrossRefPubMed
22.
Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg. 2000;232(1):10–24.CrossRefPubMedPubMedCentral
23.
24.
Lee SC, Tan HT, Chung MC. Prognostic biomarkers for prediction of recurrence of hepatocellular carcinoma: current status and future prospects. World J Gastroenterol. 2014;20(12):3112–24.CrossRefPubMedPubMedCentral
25.
Harimoto N, Yoshizumi T, Sakata K, Nagatsu A, Motomura T, Itoh S, et al. The prognostic significance of ALBI(albumin-bilirubin)-T score in patient who underwent hepatic resection for hepatocellular carcinoma. Hepatol Res. 2017;
26.
Zhou YM, Zhang XF, Li B, Sui CJ, Yang JM. Postoperative complications affect early recurrence of hepatocellular carcinoma after curative resection. BMC Cancer. 2015;15:689.CrossRefPubMedPubMedCentral
27.
Yamamoto Y, Ikoma H, Morimura R, Konishi H, Murayama Y, Komatsu S, et al. Optimal duration of the early and late recurrence of hepatocellular carcinoma after hepatectomy. World J Gastroenterol. 2015;21(4):1207–15.CrossRefPubMedPubMedCentral
28.
Wang YY, Zhong JH, ZY S, Huang JF, SD L, Xiang BD, et al. Albumin-bilirubin versus child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg. 2016;103(6):725–34.CrossRefPubMed
29.
Toyoda H, Lai PB, O'Beirne J, Chong CC, Berhane S, Reeves H, et al. Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade. Br J Cancer. 2016;114(7):744–50.CrossRefPubMedPubMedCentral
30.
Ma XL, Zhou JY, Gao XH, Tian L, Wu J, Zhang CY, et al. Application of the albumin-bilirubin grade for predicting prognosis after curative resection of patients with early-stage hepatocellular carcinoma. Clin Chim Acta. 2016;462:15–22.CrossRefPubMed
31.
Li MX, Zhao H, Bi XY, Li ZY, Huang Z, Han Y, et al. Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma: validation in a Chinese cohort. Hepatol Res. 2016;
32.
Hiraoka A, Kumada T, Michitaka K, Toyoda H, Tada T, Ueki H, et al. Usefulness of albumin-bilirubin grade for evaluation of prognosis of 2584 Japanese patients with hepatocellular carcinoma. J Gastroenterol Hepatol. 2016;31(5):1031–6.CrossRefPubMed
33.
Chan AW, Kumada T, Toyoda H, Tada T, Chong CC, Mo FK, et al. Integration of albumin-bilirubin (ALBI) score into Barcelona clinic liver cancer (BCLC) system for hepatocellular carcinoma. J Gastroenterol Hepatol. 2016;31(7):1300–6.CrossRefPubMed
34.
Chan AW, Chong CC, Mo FK, Wong J, Yeo W, Johnson PJ, et al. Incorporating albumin-bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma. J Gastroenterol Hepatol. 2016;32(1):221–8.CrossRef
35.
Teh SH, Nagorney DM, Stevens SR, Offord KP, Therneau TM, Plevak DJ, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132(4):1261–9.CrossRefPubMed
36.
Sobin LHGM, Wittekind C. International Union against Cancer (UICC): TNM classification of malignant Tumours, 7th ed. Wiley-Blackwell. 2009;
37.
Pang YY. The Brisbane 2000 terminology of liver anatomy and resections. HPB 2000; 2:333–39. HPB (Oxford) 2002; 4(2):99; author reply 99-100.
38.
39.
Kamath PS, Kim WR. Advanced liver disease study group. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797–805.CrossRefPubMed
40.
Shimada M, Takenaka K, Fujiwara Y, Gion T, Shirabe K, Yanaga K, et al. Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma. Br J Surg. 1998;85(2):195–8.CrossRefPubMed
41.
Johnston DG, Johnson GA, Alberti KG, Millward-Sadler GH, Mitchell J, Wright R. Hepatic regeneration and metabolism after partial hepatectomy in diabetic rats: effects of insulin therapy. Eur J Clin Investig. 1986;16(5):384–90.CrossRef
42.
Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute's experience with 625 patients. J Am Coll Surg. 2007;204(4):580–7.CrossRefPubMed
43.
Blumberg N, Heal JM. Effects of transfusion on immune function. Cancer recurrence and infection. Arch Pathol Lab Med. 1994;118(4):371–9.PubMed
44.
Chok KS, Ng KK, Poon RT, Lo CM, Fan ST. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg. 2009;96(1):81–7.CrossRefPubMed
45.
Hosaka T, Ikeda K, Kobayashi M, Hirakawa M, Kawamura Y, Yatsuji H, et al. Predictive factors of advanced recurrence after curative resection of small hepatocellular carcinoma. Liver Int. 2009;29(5):736–42.CrossRefPubMed
46.
Imamura H, Matsuyama Y, Tanaka E, Ohkubo T, Hasegawa K, Miyagawa S, et al. Risk factors contributing to early and late phase intrahepatic recurrence of hepatocellular carcinoma after hepatectomy. J Hepatol. 2003;38(2):200–7.CrossRefPubMed
47.
Chau GY, CW W, Lui WY, Chang TJ, Kao HL, LH W, et al. Serum interleukin-10 but not interleukin-6 is related to clinical outcome in patients with resectable hepatocellular carcinoma. Ann Surg. 2000;231(4):552–8.CrossRefPubMedPubMedCentral
48.
Nojiri T, Hamasaki T, Inoue M, Shintani Y, Takeuchi Y, Maeda H, et al. Long-term impact of postoperative complications on cancer recurrence following lung cancer surgery. Ann Surg Oncol. 2016;
49.
Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg. 2016;41(1):277–84.CrossRefPubMedCentral
50.
Tam V, Luketich JD, Winger DG, Sarkaria IS, Levy RM, Christie NA, et al. Cancer recurrence after Esophagectomy: impact of postoperative infection in propensity-matched cohorts. Ann Thorac Surg. 2016;102(5):1638–46.CrossRefPubMedPubMedCentral
51.
Chen JL, Lin XJ, Zhou Q, Shi M, Li SP, Lao XM. Association of HBV DNA replication with antiviral treatment outcomes in the patients with early-stage HBV-related hepatocellular carcinoma undergoing curative resection. Chin J Cancer. 2016;35:28.CrossRefPubMedPubMedCentral
Metadata
Title
RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma
Authors
Heng-Yuan Hsu
Ming-Chin Yu
Chao-Wei Lee
Hsin-I Tsai
Chang-Mu Sung
Chun-Wei Chen
Shu-Wei Huang
Cheng-Yu Lin
Wen-Juei Jeng
Wei-Chen Lee
Miin-Fu Chen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3748-9

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue

Research article

Down-regulation of miRNA-148a and miRNA-625-3p in colorectal cancer is associated with tumor budding

Research article

p53R2 as a novel prognostic biomarker in nasopharyngeal carcinoma

Research article

Differential long-term stability of microRNAs and RNU6B snRNA in 12–20 year old archived formalin-fixed paraffin-embedded specimens

Research article

Barriers to HPV self-sampling and cytology among low-income indigenous women in rural areas of a middle-income setting: a qualitative study

Research article

Risk of second primary cancers in cancer patients treated with cisplatin: a systematic review and meta-analysis of randomized studies

Study protocol

Contrast-enhanced US with Perfluorobutane(Sonazoid) used as a surveillance test for Hepatocellular Carcinoma (HCC) in Cirrhosis (SCAN): an exploratory cross-sectional study for a diagnostic trial
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits