Li Chuan, Zhang Xiao-Yun, Peng Wei, Wen Tian-Fu, Yan Lu-Nan, Li Bo, Yang Jia-Yin, Wang Wen-Tao, Xu Ming-Qing
Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
World J Surg. 2018 Jun;42(6):1841-1847. doi: 10.1007/s00268-017-4355-2.
Albumin-bilirubin (ALBI) grade has been validated as a simple, evidence-based, and objective prognostic tool for patients with hepatocellular carcinoma (HCC). However, minimal information is available concerning postoperative ALBI grade changes in HCC. This study aimed to investigate the prognostic value of postoperative ALBI grade changes in patients with hepatitis B virus (HBV)-related HCC within the Milan criteria after liver resection.
Patients with HBV-related HCC within the Milan criteria who underwent liver resection between 2010 and 2016 at West China Hospital were reviewed (N = 258). A change in ALBI grade was defined as first postoperative month ALBI grade-preoperative ALBI grade. If the value was >0, postoperative worsening of ALBI grade was considered; otherwise, stable ALBI grade was considered. Cox proportional hazard regression analyses were used to determine the factors that influence recurrence and survival.
During the follow-up, 130 patients experienced recurrence and 47 patients died. Multivariate analyses revealed that postoperative worsening of ALBI grade (HR 1.541, 95% CI 1.025-2.318, P = 0.038), microvascular invasion (MVI, HR 1.802, 95% CI 1.205-2.695, P = 0.004), and multiple tumors (HR 1.676, 95% CI 1.075-2.615, P = 0.023) were associated with postoperative recurrence, whereas MVI (HR 2.737, 95% CI 1.475-5.080, P = 0.001), postoperative worsening of ALBI grade (HR 2.268, 95% CI 1.227-4.189, P = 0.009), high alpha-fetoprotein level (HR 2.055, 95% CI 1.136-3.716, P = 0.017), and transfusion (HR 2.597, 95% CI 1.395-4.834, P = 0.003) negatively influenced long-term survival. Patients with postoperative worsening of ALBI grade exhibited increased incidence of recurrence and worse long-term survival.
Postoperative worsening of ALBI grade was associated with increased recurrence and poorer overall survival for patients with HBV-related HCC within the Milan criteria. We should pay attention to liver function changes in HCC patients after liver resection.
白蛋白-胆红素（ALBI）分级已被证实是一种用于肝细胞癌（HCC）患者的简单、循证且客观的预后工具。然而，关于HCC术后ALBI分级变化的信息极少。本研究旨在探讨肝切除术后ALBI分级变化对符合米兰标准的乙型肝炎病毒（HBV）相关HCC患者的预后价值。
回顾性分析2010年至2016年在华西医院接受肝切除的符合米兰标准的HBV相关HCC患者（N = 258例）。ALBI分级变化定义为术后第1个月ALBI分级减去术前ALBI分级。若该值>0，则认为术后ALBI分级恶化；否则，认为ALBI分级稳定。采用Cox比例风险回归分析来确定影响复发和生存的因素。
随访期间，130例患者出现复发，47例患者死亡。多因素分析显示，术后ALBI分级恶化（HR 1.541，95%CI 1.025 - 2.318，P = 0.038）、微血管侵犯（MVI，HR 1.802，95%CI 1.205 - 2.695，P = 0.004）和多发肿瘤（HR 1.676，95%CI 1.075 - 2.615，P = 0.023）与术后复发相关，而MVI（HR 2.737，95%CI 1.475 - 5.080，P = 0.001）、术后ALBI分级恶化（HR 2.268，95%CI 1.227 - 4.189，P = 0.009）、高甲胎蛋白水平（HR 2.055，95%CI 1.136 - 3.716，P = 0.017）和输血（HR 2.597，95%CI 1.395 - 4.834，P = 0.003）对长期生存有负面影响。术后ALBI分级恶化的患者复发率增加，长期生存较差。
对于符合米兰标准的HBV相关HCC患者，术后ALBI分级恶化与复发增加及总体生存较差相关。我们应关注HCC患者肝切除术后的肝功能变化。
