西村 渉

BACKGROUND/AIM: The Albumin-Bilirubin (ALBI) score was initially developed to estimate prognosis in patients with hepatocellular carcinoma. Recently, its prognostic relevance has been extended to intrahepatic cholangiocarcinoma; however, its impact on perihilar cholangiocarcinoma remains unclear. PATIENTS AND METHODS: A total of 71 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2007 and 2024 at Jichi Medical University were retrospectively analyzed. Preoperative blood samples were obtained within two weeks before surgery, after effective jaundice control. Survival outcomes were evaluated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for overall survival. RESULTS: Patients with ALBI Grade 1 had a significantly longer median survival time compared to those with ALBI Grade 2 or 3 (not reached vs. 45 months vs. 13 months, respectively; p=0.001). The prognostic nutritional index (PNI) was significantly lower in ALBI Grade 2/3 than in Grade 1 (41.6±5.7 vs. 49.5±5.9, p<0.001). Similarly, carbohydrate antigen 19-9 (CA19-9) levels were higher in ALBI Grade 2/3 compared to Grade 1 (493±129 vs. 98±176 U/mL, p=0.002). Multivariable analysis identified ALBI Grade 2/3 as an independent negative prognostic factor for overall survival (HR=2.14, 95% CI=1.01-4.54, p=0.047). Regression analysis showed a strong inverse correlation between ALBI score and serum albumin levels (R=-0.9624, p=0.001). CONCLUSION: ALBI score may provide valuable prognostic information for long-term outcomes in patients undergoing hepatectomy for perihilar cholangiocarcinoma.

BACKGROUND: Perihilar cholangiocarcinoma with large hepatic resection is associated with high risk for morbidity and mortality. To improve outcomes, assessment of remnant liver function is crucial. METHODS: A total of 70 patients with perihilar cholangiocarcinoma were examined retrospectively. Liver function was evaluated <1 month preoperatively by hepatic clearance of remnant liver using 99mTc-galactosyl serum albumin (GAS) scintigraphy and computed tomography, and clinicopathological data and outcomes were analyzed in comparison GSA scintigraphy with liver function test based on computed tomography volumetry. RESULTS: There was no postoperative 90-day mortality, with 10 patients of posthepatectomy liver failure (PHLF) Grade A, 10 of Grade B, and 1 of Grade C. Area under the curve of receiver operating curve showed better prediction power for PHLF compared to remnant liver volume/body surface area or future liver remnant/body weight, especially in patients with incomplete change of liver function. In univariable analysis, <150 ml/min ml/min cutoff of hepatic clearance of remnant liver and >1750 ml intra-operative blood loss were significant risk factors for PHLF. In multivariable analysis, <150 ml/min cutoff was a significant risk factor for PHLF. The area under the curve of hepatic clearance of remnant liver indicated better predictivity in patients with incomplete change of liver function compared with complete change of liver function. CONCLUSIONS: The hepatic clearance of remnant liver may have predictive power in patients with incomplete changes in liver function compared to computed tomography-based methods. Preoperative measurement of hepatic clearance of remnant liver may assist in risk stratification for surgical management.

BACKGROUND: This study aimed to elucidate the clinical impact of osteopenia on the recurrence of colon cancer liver metastases. METHODS: Patients with colon cancer liver metastases (N = 186) undergoing hepatectomy at Jichi Medical University Hospital between March 2006 and March 2020 were examined retrospectively. Computed tomography (CT) scans on the 11th vertebra within 3 months of surgery assessed bone mineral density (BMD). Age-adjusted BMD determined osteopenia presence. Kaplan-Meier method with a log-rank test estimated survival. Factors associated with survival were assessed using Cox's proportional hazards model after adjustment for confounders. RESULTS: Patients with osteopenia had shorter overall (p = 0.0001; 5-year overall survival, 51.8% vs 81.8%) and recurrence-free survival (p = 0.0008, 5-year recurrence-free survival: 26.3% vs 51.5%) than BMD-normal patients. In multivariable analysis, the risk factor for overall survival was osteopenia (Hazard ratio (HR) 3.79, 95% confidence interval (CI) 2.09-6.87, p = 0.001). Risk factors for recurrence were chemotherapy (HR 1.92, 95%CI 1.12-3.30, p = 0.002), tumor number (HR 1.51, 95%CI 1.02-2.27, p = 0.04), and osteopenia (HR 2.18, 95%CI 1.46-3.24 p = 0.001). Patients with osteopenia are more likely to develop lung metastases, and BMD-value reduction associated with KRAS mutation. CONCLUSION: Osteopenia may have prognostic significance in patients with liver metastases colorectal cancer.