Kuo Yuan-Hung, Wang Jing-Houng, Hung Chao-Hung, Rau Kun-Ming, Wu I-Pei, Chen Chien-Hung, Kee Kwong-Ming, Hu Tsung-Hui, Lu Sheng-Nan
Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Gastroenterol Hepatol. 2017 Dec;32(12):1975-1981. doi: 10.1111/jgh.13783.
The Albumin-Bilirubin (ALBI) grade is a new index to assess objectively liver function and prognosis in patients with hepatocellular carcinoma (HCC). This study aimed to elucidate the application of ALBI grade in baseline and sorafenib-end in advanced HCC patients who received sorafenib.
A total of 415 consecutive advanced HCC patients in Child-Pugh A received sorafenib in our hospital. Sorafenib was terminated when radiologic tumor progression or clinical liver function deterioration (LD) occurred in the reassessment bimonthly. Patients who failed with sorafenib monotherapy were retrospectively analyzed.
A total of 260 (62.6%) patients were enrolled, including 98 (37.7%) ALBI grade I and 162 (62.3%) grade II in baseline. More patients in ALBI grade II stopped sorafenib because of LD than in grade I (33.3% vs 14.3%, P < 0.001). Those who in baseline ALBI grade I had a superior overall survival than in grade II (8.5 months vs 4.4 months, P = 0.003). Cox regression analysis confirmed that baseline ALBI grade II (P < 0.001) and ALBI grade increase during treatment (P < 0.001) strongly contributed to the mortality of HCC patients who received sorafenib. After sorafenib failure, those with post-sorafenib treatment had a better post-sorafenib survival than those without (9.3 vs 1.6 months, P < 0.001). Logistic regression analysis indicated that sorafenib-end ALBI grade and LD occurrence were the only two predictors of post-sorafenib treatment after sorafenib failure.
In clinical practice, we firstly demonstrated that not only ALBI grade in baseline but also ALBI grade change during treatment could predict the prognosis of advanced HCC patients who received sorafenib.
白蛋白-胆红素（ALBI）分级是一种客观评估肝细胞癌（HCC）患者肝功能及预后的新指标。本研究旨在阐明ALBI分级在接受索拉非尼治疗的晚期HCC患者基线期及索拉非尼治疗结束时的应用情况。
我院共有415例连续入组的Child-Pugh A级晚期HCC患者接受索拉非尼治疗。每两个月进行一次重新评估，当出现影像学肿瘤进展或临床肝功能恶化（LD）时停用索拉非尼。对索拉非尼单药治疗失败的患者进行回顾性分析。
共纳入260例（62.6%）患者，基线期包括98例（37.7%）ALBI I级和162例（62.3%）II级。与I级相比，更多ALBI II级患者因LD而停用索拉非尼（33.3%对14.3%，P<0.001）。基线期ALBI I级患者的总生存期优于II级患者（8.5个月对4.4个月，P = 0.003）。Cox回归分析证实，基线ALBI II级（P<0.001）和治疗期间ALBI分级升高（P<0.001）是接受索拉非尼治疗的HCC患者死亡的重要因素。索拉非尼治疗失败后，接受索拉非尼后续治疗的患者索拉非尼治疗后的生存期优于未接受者（9.3对1.6个月，P<0.001）。Logistic回归分析表明，索拉非尼治疗结束时的ALBI分级和LD的发生是索拉非尼治疗失败后索拉非尼后续治疗仅有的两个预测因素。
在临床实践中，我们首次证明，不仅基线期的ALBI分级，而且治疗期间的ALBI分级变化均可预测接受索拉非尼治疗的晚期HCC患者预后。
