Chan Stephen L, Mo Frankie, Johnson Philip, Li Leung, Tang Nelson, Loong Herbert, Chan Anthony W H, Koh Jane, Chan Anthony T C, Yeo Winnie
State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
J Gastroenterol Hepatol. 2015 Oct;30(10):1529-35. doi: 10.1111/jgh.13005.
The BALAD score is developed to provide an objective determination of prognosis for hepatocellular carcinoma (HCC) by incorporating five serum markers, namely albumin, bilirubin, alpha-fetoprotein (AFP), agglutinin-reactive alpha-fetoprotein (AFP-L3), and des-γ-carboxy prothrombin. We aim to study the applicability of BALAD score and prognostication of the three tumor markers in hepatitis B virus-related HCC.
Patients with newly diagnosed HCC were prospectively enrolled. All of the baseline characteristics and serum albumin and bilirubin level were documented at baseline. The levels of the three tumor markers (AFP, AFP-L3, and des-γ-carboxy prothrombin) were determined in archival serum samples. Patients were followed up for survivals according to local practice. The prognostic performances of the three markers and BALAD score were studied in association with overall survival (OS).
A total of 198 patients with hepatitis B-related HCC were recruited. AFP and AFP-L3 levels were independent prognostic factors. The number of elevated tumor markers was also predictive of worse OS. BALAD score could stratify the cohort into different patient groups with distinct median OS. The median OS of BALAD score of 0, 1, 2, 3, and 4 was not reached, 26.6, 8.3, 2.6, and 1.9 months, respectively (P < 0.0001). BALAD score could further stratify outcomes in each Barcelona Clinic Liver Cancer (BCLC) subgroup. In particular, BALAD score of 3-4 had median OS of 2.6 months only in BCLC stage C patients.
BALAD score is applicable in the population of hepatitis B virus-related HCC. The combined use of BALAD score and BCLC staging system could help identify more suitable candidates for clinical trial.
BALAD评分通过纳入白蛋白、胆红素、甲胎蛋白（AFP）、凝集素反应性甲胎蛋白（AFP-L3）和去γ-羧基凝血酶原这五项血清标志物，用于对肝细胞癌（HCC）的预后进行客观判定。我们旨在研究BALAD评分在乙型肝炎病毒相关HCC中的适用性以及这三种肿瘤标志物的预后价值。
前瞻性纳入新诊断的HCC患者。记录所有患者的基线特征以及基线时的血清白蛋白和胆红素水平。在存档血清样本中测定三种肿瘤标志物（AFP、AFP-L3和去γ-羧基凝血酶原）的水平。根据当地实际情况对患者进行生存随访。研究这三种标志物和BALAD评分与总生存期（OS）相关的预后性能。
共招募了198例乙型肝炎相关HCC患者。AFP和AFP-L3水平是独立的预后因素。肿瘤标志物升高的数量也可预测较差的OS。BALAD评分可将队列分为不同的患者组，各有不同的中位OS。BALAD评分为0、1、2、3和4时的中位OS分别为未达到、26.6个月、8.3个月、2.6个月和1.9个月（P＜0.0001）。BALAD评分可在每个巴塞罗那临床肝癌（BCLC）亚组中进一步分层预后结果。特别是，BALAD评分为3 - 4时，仅在BCLC C期患者中的中位OS为2.6个月。
BALAD评分适用于乙型肝炎病毒相关HCC人群。联合使用BALAD评分和BCLC分期系统有助于识别更适合进行临床试验的患者。
