Gui Bin, Weiner Ashley A, Nosher John, Lu Shou-En, Foltz Gretchen M, Hasan Omar, Kim Seung K, Gendel Vyacheslav, Mani Naganathan B, Carpizo Darren R, Saad Nael E, Kennedy Timothy J, Zuckerman Darryl A, Olsen Jeffrey R, Parikh Parag J, Jabbour Salma K
Department of Radiation Oncology.
Department of Radiation Oncology, Washington University School of Medicine.
Am J Clin Oncol. 2018 Sep;41(9):861-866. doi: 10.1097/COC.0000000000000384.
As the utility of Child-Pugh (C-P) class is limited by the subjectivity of ascites and encephalopathy, we evaluated a previously established objective method, the albumin-bilirubin (ALBI) grade, as a prognosticator for yttrium-90 radioembolization (RE) treatment for patients with hepatocellular carcinoma (HCC).
A total of 117 patients who received RE for HCC from 2 academic centers were reviewed and stratified by ALBI grade, C-P class, and Barcelona Clinic Liver Cancer stage. The overall survival (OS) according to these 3 criteria was evaluated by Kaplan-Meier survival analysis. The utilities of C-P class and ALBI grade as prognostic indicators were compared using the log-rank test. Multivariate Cox regression analysis was performed to identify additional predictive factors.
Patients with ALBI grade 1 (n=49) had superior OS than those with ALBI grade 2 (n=65) (P=0.01). Meanwhile, no significant difference was observed in OS between C-P class A (n=100) and C-P class B (n=14) (P=0.11). For C-P class A patients, the ALBI grade (1 vs. 2) was able to stratify 2 clear and nonoverlapping subgroups with differing OS curves (P=0.03). Multivariate Cox regression test identified alanine transaminase, Barcelona Clinic Liver Cancer stage, and ALBI grade as the strongest prognostic factors for OS (P<0.10).
ALBI grade as a prognosticator has demonstrated clear survival discrimination that is superior to C-P class among HCC patients treated with RE, particularly within the subgroup of C-P class A patients. ALBI grade is useful for clinicians to make decisions as to whether RE should be recommended to patients with HCC.
由于Child-Pugh（C-P）分级的实用性受到腹水和肝性脑病主观性的限制，我们评估了一种先前建立的客观方法——白蛋白-胆红素（ALBI）分级，作为肝细胞癌（HCC）患者钇-90放射性栓塞（RE）治疗的预后指标。
回顾了来自2个学术中心接受HCC的RE治疗的117例患者，并根据ALBI分级、C-P分级和巴塞罗那临床肝癌分期进行分层。通过Kaplan-Meier生存分析评估根据这3项标准的总生存期（OS）。使用对数秩检验比较C-P分级和ALBI分级作为预后指标的效用。进行多变量Cox回归分析以确定其他预测因素。
ALBI 1级患者（n = 49）的OS优于ALBI 2级患者（n = 65）（P = 0.01）。同时，C-P A级患者（n = 100）和C-P B级患者（n = 14）的OS无显著差异（P = 0.11）。对于C-P A级患者，ALBI分级（1级与2级）能够将具有不同OS曲线的2个清晰且不重叠的亚组进行分层（P = 0.03）。多变量Cox回归检验确定谷丙转氨酶、巴塞罗那临床肝癌分期和ALBI分级是OS的最强预后因素（P < 0.10）。
在接受RE治疗的HCC患者中，尤其是在C-P A级患者亚组中，ALBI分级作为一种预后指标已显示出明显的生存差异，优于C-P分级。ALBI分级有助于临床医生决定是否应向HCC患者推荐RE治疗。
