Nutritional Risk Predicts Hepatic Regeneration After Associating Liver Partition and Portal Vein Ligation for Staged...

This study aimed to evaluate whether preoperative nutritional risk, as measured by the NRS-2002 score, predicts hepatic regeneration after ALPPS in patients with HBV-related HCC.

Among the 54 patients who completed both ALPPS stages, intervals to adequate regeneration were dichotomized (≤14 vs. >14 d). Logistic regression identified predictors of prolonged intervals, and a nomogram was developed.

Univariable and multivariable logistic analyses revealed that the NRS-2002 score (≥3), resected-side portal vein thrombosis (PVT), and decreased prealbumin (pre-ALB) levels were independently identified as preoperative risk factors for prolonged intervals. The nomogram showed exploratory accuracy in estimating the prolonged interval, with an AUC of 0.905 (95% CI:0.828-0.981). It should be noted that the wide confidence intervals for the predictor odds ratios (e.g., NRS-2002 ≥3: OR = 11.406, 95% CI: 1.481-87.841) reflect the uncertainty inherent to the sample size, and the model may be susceptible to overfitting. However, the relatively wide confidence intervals for key predictors and the modest sample size warrant caution against overfitting, and external validation is required before clinical application. Correlation analysis revealed a statistically significant positive association was observed between standard future liver remnant (sFLR)/standard liver volume (SLV) before stage 1 and sFLR/SLV before stage 2. Patients with lower NRS-2002 scores had better survival outcomes than those with higher scores.

Preoperative NRS-2002 score, prealbumin, and portal vein thrombosis may help identify patients with HBV-related HCC at risk for delayed regeneration after ALPPS. However, these findings require validation in intention-to-treat cohorts.