ArticleBMC cancer2023
Prognostic implications of alpha-fetoprotein and C-reactive protein elevation in hepatocellular carcinoma following resection (PACE): a large cohort study of 2770 patients.
Article in BMC cancer, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 10 citations in OpenAlex.
- Elevated baseline C-reactive protein is associated with treatment failure and shorter survival after Yttrium-90 radioembolization in hepatocellular carcinoma.Annals of nuclear medicine · 2026Article
- CRAFITY and PALBI Define a Machine Learning-Supported Prognostic Framework in Hepatocellular Carcinoma-Data from an Eastern European Cohort with Low Macrotrabecular-Massive Prevalence.Diseases (Basel, Switzerland) · 2026Article
- Development of a predictive model for lung metastasis in hepatocellular carcinoma patients: insights from SEER database analysis.Updates in surgery · 2025Article
- Prognostic Significance of Elevated Platelet Count (>200 x 10^9 per L) in BCLC Stages B and C of Hepatocellular Carcinoma: A Retrospective Multicenter Analysis.Journal of hepatocellular carcinoma · 2025Article
- Multidisciplinary Team (MDT)-Based Approaches for Liver Cancer Treatment: A Discussion Paper on Tumor Boards and Beyond.Journal of multidisciplinary healthcare · 2025Review
- Modified Glasgow Prognostic Score Incorporating CRP/Albumin Ratio and LDH Levels as Prognostic Indicators in Patients with Multiple Myeloma: A Retrospective Study.Cancer management and research · 2025Article
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18 authors at 11 institutions in 1 country.
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Abstract
backgroundRoutine clinical staging for hepatocellular carcinoma (HCC) incorporates liver function, general health, and tumor morphology. Further refinement of prognostic assessments and treatment decisions may benefit from the inclusion of tumor biological marker alpha-fetoprotein (AFP) and systemic inflammation indicator C-reactive protein (CRP).
methodsData from a multicenter cohort of 2770 HCC patients undergoing hepatectomy were analyzed. We developed the PACE risk score (Prognostic implications of AFP and CRP Elevation) after initially assessing preoperative AFP and CRP's prognostic value. Subgroup analyzes were performed in BCLC cohorts A and B using multivariable Cox analysis to evaluate the prognostic stratification ability of the PACE risk score and its complementary utility for BCLC staging.
resultsPreoperative AFP ≥ 400ng/mL and CRP ≥ 10 mg/L emerged as independent predictors of poorer prognosis in HCC patients who underwent hepatectomy, leading to the creation of the PACE risk score. PACE risk score stratified patients into low, intermediate, and high-risk groups with cumulative 5-year overall (OS) and recurrence-free survival (RFS) rates of 59.6%/44.9%, 43.9%/38.4%, and 20.6%/18.0% respectively (all P < 0.001). Increased PACE risk scores correlated significantly with early recurrence and extrahepatic metastases frequency (all P < 0.001). The multivariable analysis identified intermediate and high-risk PACE scores as independently correlating with poor postoperative OS and RFS. Furthermore, the PACE risk score proficiently stratified the prognosis of BCLC stages A and B patients, with multivariable analyses demonstrating it as an independent prognostic determinant for both stages.
conclusionThe PACE risk score serves as an effective tool for postoperative risk stratification, potentially supplementing the BCLC staging system.
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