Exploratory evaluation of combined handgrip strength and Age-Adjusted Charlson Comorbidity Index for prognosis in patients with primary liver cancer undergoing hepatectomy: a single-centre pilot study.

OBJECTIVE: To investigate whether preoperative handgrip strength and the Age-Adjusted Charlson Comorbidity Index (ACCI), alone and in combination, predict overall survival and recurrence-free survival in patients with primary liver cancer undergoing curative-intent hepatectomy. MATERIALS AND METHODS: This prospective single-centre pilot study consecutively enrolled patients with pathologically confirmed primary liver cancer who underwent curative-intent hepatectomy at The First Affiliated Hospital of Chengdu Medical College between January 2020 and December 2022. Handgrip strength was measured preoperatively using a calibrated dynamometer. ACCI was calculated from documented comorbidities with age adjustment. Overall survival and recurrence-free survival were estimated by Kaplan-Meier analysis and compared by log-rank testing. Cox proportional hazards models were used to identify independent prognostic factors. RESULTS: A total of 1,134 patients were screened, and 783 patients were ultimately included in this study. Low handgrip strength was more frequent in females, patients aged >65 years, higher tumor stage, and those with reduced total protein, and reduced albumin. High ACCI was more frequently observed in patients with hypertension, diabetes, elevated AST, elevated ALT, reduced total protein, and reduced albumin. In multivariable analyses, tumor stage, handgrip strength, and ACCI were independent predictors of overall survival and recurrence-free survival. Patients with concomitantly low handgrip strength and high ACCI had significantly poorer overall survival and recurrence-free survival compared with those with high handgrip strength and low ACCI. The combined handgrip strength and ACCI model provided preliminary evidence of incremental prognostic discrimination compared with either marker alone. CONCLUSION: Preoperative handgrip strength and ACCI independently predict overall survival and recurrence-free survival after hepatectomy for primary liver cancer, and their combination improves prognostic stratification, which may offer a tool for perioperative risk assessment and individualized surveillance planning.