Prognostic factors after curative treatments for Milan criteria hepatocellular carcinoma in Child-Pugh A from the view of portal hypertension, muscle volume and BTR

Abstract

This study aimed to clarify the clinical features of patients in whom nutritional intervention should be initiated. Of the 408 patients with first-episode liver cancer diagnosed between 2005 and 2021, patients were Child-Pugh A and within the Milan criteria who were evaluated for muscle volume loss (MVL) by Psoas muscle index (PMI) on CT data, esophagogastric varices (EGV) by upper gastrointestinal endoscopy and curative treatment. Liver function was evaluated by modified albumin-bilirubin grade (mALBI), and patients with portal hypertension (PHT) were defined as F2 or higher/treatment history+. BTR less than 4.4 was defined as having amino acid imbalance (AAI), and overall survival was analyzed retrospectively. Patients with PHT and MVL had a higher rate of AAI complications than those without PHT (75.0% vs. 32.9%, p = 0.009). (MST 79.1-91.3 months vs. 140.7 months, p = 0.003). 75 years or older (HR 2.42), mALBI < 2b (HR 1.81), MVL (HR 1.55), PHT (HR 1.672), (respectively p < 0.05) were prognostic factors. ALBI predicting AAI was -2.586 (AUC 0.789). Nutritional intervention should be aggressively implemented to prevent progression to MVL, because AAI has already begun to occur not only LC with PHT even in Child-Pugh A but also those show a worsening trend from mALBI 1 to 2a.