Ho Shu-Yein, Liu Po-Hong, Hsu Chia-Yang, Hsia Cheng-Yuan, Lee Yun-Hsuan, Lee Rheun-Chuan, Huang Yi-Hsiang, Lee Fa-Yauh, Hou Ming-Chih, Tsai Ya-Ju, Huo Teh-Ia
Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
PLoS One. 2017 Jul 3;12(7):e0180408. doi: 10.1371/journal.pone.0180408. eCollection 2017.
Various noninvasive liver reserve markers were proposed to indicate the severity of liver damage. However, the role and feasibility of these markers to predict the prognosis of patients with hepatocellular carcinoma (HCC) are unknown. We aimed to identify the prognostic role of the 8 currently used hepatic reserve markers in patients with HCC undergoing transarterial chemoembolization (TACE).
Between 2002 and 2013, a total of 881 patients with HCC undergoing TACE were prospectively identified and retrospectively analyzed. The baseline characteristics, tumor status and noninvasive markers were collected. Homogeneity and corrected Akaike information criteria (AICc) were compared between these markers. The Cox proportional hazards model was used to identify independent predictors of survival.
Significant differences in survival distribution were found for albumin-bilirubin (ALBI) grade, Child-Turcotte-Pugh (CTP) class, Lok index, fibrosis index based on 4 factors (FIB-4), Göteborg University cirrhosis index (GUCI), cirrhosis discriminant index (CDI) and model for end-stage liver disease (MELD) score (all p values <0.05). Among these markers, the ALBI grade showed the highest homogeneity and lowest AICc value, indicating a better prognostic performance. Cox multivariate analysis confirmed that ALBI grade 2, ascites, serum alkaline phosphatase and α-fetoprotein level, tumor diameter, vascular invasion and performance status were significant independent prognostic predictors. The distribution of the ALBI score well correlated with baseline CTP and MLED scores.
Our data suggest that among the currently used liver reserve markers, ALBI grade may serve as an objective and feasible surrogate to predict the prognosis of HCC patients undergoing TACE.
人们提出了各种非侵入性肝储备标志物来指示肝损伤的严重程度。然而，这些标志物在预测肝细胞癌（HCC）患者预后方面的作用和可行性尚不清楚。我们旨在确定目前使用的8种肝储备标志物在接受经动脉化疗栓塞（TACE）的HCC患者中的预后作用。
2002年至2013年期间，前瞻性确定并回顾性分析了881例接受TACE的HCC患者。收集了基线特征、肿瘤状态和非侵入性标志物。比较了这些标志物之间的同质性和校正的赤池信息准则（AICc）。采用Cox比例风险模型确定生存的独立预测因素。
白蛋白-胆红素（ALBI）分级、Child-Turcotte-Pugh（CTP）分级、Lok指数、基于4个因素的纤维化指数（FIB-4）、哥德堡大学肝硬化指数（GUCI）、肝硬化判别指数（CDI）和终末期肝病模型（MELD）评分的生存分布存在显著差异（所有p值<0.05）。在这些标志物中，ALBI分级显示出最高的同质性和最低的AICc值，表明其预后性能更好。Cox多变量分析证实，ALBI 2级、腹水、血清碱性磷酸酶和甲胎蛋白水平、肿瘤直径、血管侵犯和体能状态是显著的独立预后预测因素。ALBI评分的分布与基线CTP和MLED评分密切相关。
我们的数据表明，在目前使用的肝储备标志物中，ALBI分级可作为预测接受TACE的HCC患者预后的客观可行替代指标。
