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Baseline Liver Function Predicts Long-Term Survival Beyond Perioperative Outcomes After Liver Resection for Biliary
Yawen Dong1,2, Zhihao Li3, David Pereyra1,4
1Department of Surgery, Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA.
Annals of Surgical Oncology
|July 2, 2026
Summary
The aspartate aminotransferase-to-platelet ratio index + albumin-bilirubin (APRI+ALBI) score predicts long-term survival in biliary tract cancer (BTC) patients undergoing resection. A higher APRI+ALBI score indicates poorer hepatic function and is linked to worse overall survival and recurrence-free survival.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Liver Function Assessment
Background:
- The aspartate aminotransferase-to-platelet ratio index + albumin-bilirubin (APRI+ALBI) score is utilized for risk stratification of posthepatectomy liver failure (PHLF).
- The predictive value of baseline hepatic function, assessed by APRI+ALBI, for long-term survival in biliary tract cancer (BTC) remains under investigation.
Purpose of the Study:
- To evaluate whether the preoperative APRI+ALBI score predicts long-term survival in patients with biliary tract cancer (BTC) undergoing curative-intent liver resection.
- To determine the independent prognostic value of baseline hepatic functional reserve for overall survival (OS) and recurrence-free survival (RFS) in BTC.
Main Methods:
- A cohort of 683 patients undergoing curative-intent liver resection for BTC (perihilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, gallbladder cancer) between 2000 and 2024 was analyzed.
- Patients were stratified into high and low APRI+ALBI score groups. 1:1 direct matching was performed based on tumor type, age, sex, and ECOG status to minimize baseline imbalances.
- Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier methods and multivariable Cox proportional hazards regression.
Main Results:
- Among 616 patients with available APRI+ALBI scores, high scores (indicating poorer hepatic function) were associated with male sex, perihilar cholangiocarcinoma, major hepatectomy, vascular resection, lymph node positivity, and advanced tumor stage.
- Patients with high APRI+ALBI scores experienced increased rates of major postoperative complications, PHLF grade B/C, and 90-day mortality.
- Median OS was 39.8 months in the high APRI+ALBI group versus 62.9 months in the low group (p = 0.004), and median RFS was 22.2 months versus 27.4 months (p = 0.019), respectively. These differences persisted after matching, and APRI+ALBI remained an independent predictor of survival.
Conclusions:
- The preoperative APRI+ALBI score is an independent predictor of survival following curative-intent resection for BTC.
- Baseline hepatic functional reserve, as indicated by the APRI+ALBI score, is clinically relevant and impacts oncologic outcomes beyond perioperative risk in BTC patients.
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