Preoperative Total Iron‐Binding Capacity Is a Novel Surrogate Marker of Short‐ and Long‐Term Outcomes After Liver Resection for Hepatocellular Carcinoma

ABSTRACT Background This study aimed to examine whether preoperative serum total iron‐binding capacity (TIBC), which is directly proportional to transferrin level, correlates with short‐ and long‐term outcomes after hepatectomy. Methods Preoperative TIBC levels, calculated by summing serum iron and unsaturated iron binding capacity, were evaluated in 577 patients who underwent hepatectomy for hepatocellular carcinoma. We defined TIBC < 274 μg/dL calculated by receiver‐operating characteristic (ROC) analysis as low TIBC. We evaluated the relationship between preoperative TIBC levels and short‐ and long‐term outcomes after hepatectomy. Results Low preoperative TIBC levels were correlated with lower body mass index, worse Child Pugh score, lower albumin, higher CRP, lower hemoglobin, lower serum iron, higher controlling nutritional status (CONUT) score, lower prognostic nutritional index (PNI), and larger tumor size compared to those in high TIBC levels ( p = 0.0070, 0.0098, < 0.0001, 0.0008, 0.0086, 0.0018, 0.0008, < 0.0001, and 0.016, respectively). Patients with low preoperative TIBC levels experienced significantly more frequent postoperative complications of Clavien–Dindo classification (CDc) ≥ II and III in univariate and multivariate analyses (CDc≥II; hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.010–2.799, p = 0.046/CDc≥III; hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.015–3.506, p = 0.045). Furthermore, these patients were significantly correlated with worse overall survival (OS) and relapse free survival (RFS) in univariate and multivariate analyses (OS; HR 3.24, 95% CI 1.783–5.805, p = 0.0002/RFS; HR 1.65, 95% CI 1.009–2.720, p = 0.046). Conclusion Preoperative serum TIBC levels may be a novel surrogate marker of postoperative complications and long‐term survival after hepatectomy.