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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.
Background:
The aspartate aminotransferase-to-platelet ratio index + albumin-bilirubin (APRI+ALBI) score reflects hepatic functional reserve and is widely used for risk stratification of posthepatectomy liver failure (PHLF). However, whether baseline hepatic function also predicts long-term survival in biliary tract cancer (BTC) remains unclear.
Patients And Methods:
Patients undergoing curative-intent liver resection for BTC (perihilar cholangiocarcinoma [pCCA], intrahepatic cholangiocarcinoma [iCCA], gallbladder cancer [GBC]) at Mayo Clinic Rochester between 2000 and 2024 were analyzed. Patients were stratified into APRI+ALBI high and low groups using the previously published cutoff (- 2.46). To minimize baseline imbalances, 1:1 direct matching based on tumor type, age, sex, and Eastern Cooperative Oncology Group (ECOG) status was performed. OS and RFS were analyzed using Kaplan-Meier methods with log-rank testing and multivariable Cox proportional hazards regression analysis.
Results:
Among 683 eligible patients, 616 with available APRI+ALBI scores were included in the analysis. High (poor) APRI+ALBI scores were associated with male sex, pCCA, more frequent major hepatectomy and vascular resection, and higher rates of lymph node positivity and advanced tumor stage. This group also experienced increased rates of major postoperative complications, PHLF grade B/C, and 90-day mortality. Correspondingly, median OS and RFS were significantly worse in the high APRI+ALBI group (OS: 39.8 versus 62.9 months, p = 0.004; RFS: 22.2 versus 27.4 months, p = 0.019). These significant differences persisted after direct matching, and APRI+ALBI remained an independent predictor of both outcomes on multivariable Cox regression.
Conclusions:
Preoperative APRI+ALBI score independently predicts survival after curative-intent resection for BTC, supporting a clinically relevant link between baseline hepatic functional reserve and oncologic outcomes beyond perioperative risk.
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