Kanda Mitsuro, Tanaka Chie, Kobayashi Daisuke, Uda Hiroaki, Inaoka Kenichi, Tanaka Yuri, Hayashi Masamichi, Iwata Naoki, Yamada Suguru, Fujii Tsutomu, Sugimoto Hiroyuki, Murotani Kenta, Fujiwara Michitaka, Kodera Yasuhiro
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Center for Clinical Research, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, 4801195, Japan.
World J Surg. 2018 Mar;42(3):773-781. doi: 10.1007/s00268-017-4234-x.
The albumin-bilirubin (ALBI) score was initially developed for assessing liver dysfunction severity and was suggested to have prognostic value in patients with hepatocellular carcinoma. We aimed to evaluate the prognostic impact of ALBI grade in patients with advanced gastric cancer (GC) after radical gastrectomy.
This study included 283 patients who underwent radical gastrectomy for pT2-4 GC without preoperative treatment. ALBI was calculated as follows: (log bilirubin (μmol/L) × 0.66) + (albumin (g/L) × -0.0852) and categorized into grades 1 (≤-2.60), 2 (-2.60<, ≤-1.39) and 3 (-1.39<).
The median ALBI score was -2.96, and a number of patients in ALBI grades 1, 2 and 3 were 228, 55 and 0, respectively. Patients with ALBI grade 2 had a lower administration rate of adjuvant chemotherapy than those with ALBI grade 1, whereas no significant differences were found in morbidity rate and disease stage. The ALBI grade 2 group was more likely to have shorter disease-specific and disease-free survival compared with the ALBI grade 1 group. Multivariable analysis identified ALBI grade 2 as an independent prognostic factor for disease-free survival (hazard ratio 1.97, 95% confidence interval 1.10-3.47, p = 0.0242). Survival differences between ALBI grade 1 and 2 groups were increased in the patient subset that received adjuvant chemotherapy. ALBI grade 2 was correlated with a shortened duration of administration of postoperative S-1 adjuvant.
ALBI grade serves as a simple and promising predictive factor for disease-free and disease-specific survival in patients with pT2-4 GC after radical gastrectomy.
白蛋白-胆红素（ALBI）评分最初用于评估肝功能障碍的严重程度，并被认为对肝细胞癌患者具有预后价值。我们旨在评估ALBI分级对进展期胃癌（GC）患者根治性胃切除术后的预后影响。
本研究纳入283例未经术前治疗的pT2-4期GC患者，这些患者接受了根治性胃切除术。ALBI的计算方法如下：（log胆红素（μmol/L）×0.66）+（白蛋白（g/L）×-0.0852），并分为1级（≤-2.60）、2级（-2.60＜，≤-1.39）和3级（-1.39＜）。
ALBI评分中位数为-2.96，ALBI 1级、2级和3级的患者数量分别为228例、55例和0例。ALBI 2级患者辅助化疗的给药率低于ALBI 1级患者，而在发病率和疾病分期方面未发现显著差异。与ALBI 1级组相比，ALBI 2级组的疾病特异性生存和无病生存更可能较短。多变量分析确定ALBI 2级是无病生存的独立预后因素（风险比1.97，95%置信区间1.10-3.47，p = 0.0242）。在接受辅助化疗的患者亚组中，ALBI 1级和2级组之间的生存差异增加。ALBI 2级与术后S-1辅助化疗给药时间缩短相关。
ALBI分级是pT2-4期GC患者根治性胃切除术后无病生存和疾病特异性生存的一个简单且有前景的预测因素。
