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Background: Most patients ith hepatocellular carcinoma HCC have underlying liver disease, therefore, precise preoperative evaluation of the patients liver function is essential. Methods: We developed a simple grading system incorporating only to variables, namely, the serum albumin level and the indocyanine green retention rate at 15 minutes, to assess the preoperative liver function, based on the overall survival of 1868 patients ith HCC ho underent liver resection. We then tested the model in a European cohort n = 70 and analyzed the predictive poer of the grading system for the postoperative short-term outcome in a Japanese cohort. Results: The Albumin-Indocyanine Green Evaluation ALICE grading system as developed in a randomly assigned training cohort: linear predictor = 0.663 xD7; log10 ICG R15 percent - 0.0718 xD7; albumin gdL cut-off value: -2.20 and -1.39 . This ne grading system shoed a predictive poer for the overall survival similar to the Child-Pugh grading system in the validation cohort. Determination of the ALICE grade in Child-Pugh A patients alloed further stratification of the postoperative prognosis median survival time: grade 1, 12.5 y; grade 2, 6.45 y; grade 3, 3.37 y . This result as reproducible in the European cohort. Determination of the ALICE grade alloed better prediction of the risk of postoperative liver failure and mortality ascites: grade 1, 2.1 percent; grade 2, 6.5 percent; grade 3, 16.0 percent; mortality: grade 1, 0 percent; grade 2, 1.3 percent; grade 3, 5.3 percent than the previously reported model based on the presenceabsence of portal hypertension. The ALICE grade 2 as further divided into 2 groups 2a and2b using the median linear predictor -1.88 as a cut-off value. Although major resection did not affect the incidence of ascites or the mortality rate in the ALICE grade 2a group, major resection in the ALICE grade 2b group had a significantly higher incidence of ascites and mortality rate. Conclusions: This ne grading system is a simple and objective method for prediction of the postoperative long-term and short-term outcomes. This ne system could be potentially used orldide for surgical decision making in patients ith HCC.,J Clin Oncol 34, 2016 suppl; abstr 4066 00:00.0,Gastrointestinal Noncolorectal Cancer
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