Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Sci Rep. 2018 Jan 16;8(1):843. doi: 10.1038/s41598-018-19251-y.
Liver functional capacity is a crucial survival determinant for hepatocellular carcinoma (HCC). Noninvasive models were proposed to assess hepatic reserve, but their performance in outcome prediction is unclear. We aimed to investigate 10 currently used liver function models in HCC patients undergoing radiofrequency ablation (RFA). A total 499 HCC patients were prospectively identified. Homogeneity and corrected Akaike information criteria (AICc) were compared. Cox proportional hazards model was used to identify independent survival predictors. Significance survival differences were found across 10 noninvasive models (all p < 0.001) except for GUCI and APRI grade 2 vs 3, and King's score grade 1 vs 2. Among these models, ALBI grade showed the highest homogeneity and lowest AICs value, indicating a better prognostic performance. Within Child-Turcotte-Pugh (CTP) score 5 group, significant survival difference was demonstrated between ALBI grade 1 and 2 (p < 0.001); for those with CTP score 6 or higher, only ALBI grade 2 and 3 showed survival difference (p < 0.001). Cox analysis disclosed that ALBI grade, tumor size and performance status were independent prognostic predictors. There was significant correlation between CTP score and other 9 models. We conclude that ALBI grade may serve as objective and feasible surrogate for prognostic prediction in HCC patients undergoing RFA.
肝功能是肝细胞癌（HCC）患者生存的关键决定因素。目前已经提出了一些非侵入性模型来评估肝储备功能，但其在预后预测方面的性能尚不清楚。本研究旨在探讨 10 种目前用于接受射频消融（RFA）治疗的 HCC 患者的肝功能模型。前瞻性纳入 499 例 HCC 患者。比较了同质性和校正后的 Akaike 信息准则（AICc）。使用 Cox 比例风险模型来确定独立的生存预测因素。在 10 种非侵入性模型中均发现了显著的生存差异（均 p<0.001），但 GUCI 和 APRI 分级 2 与 3 以及 King 评分分级 1 与 2 除外。在这些模型中，ALBI 分级显示出最高的同质性和最低的 AICs 值，表明其预后性能更好。在 Child-Turcotte-Pugh（CTP）评分 5 组中，ALBI 分级 1 和 2 之间的生存差异显著（p<0.001）；对于 CTP 评分 6 或更高的患者，只有 ALBI 分级 2 和 3 之间的生存差异显著（p<0.001）。Cox 分析显示，ALBI 分级、肿瘤大小和体能状态是独立的预后预测因素。CTP 评分与其他 9 种模型之间存在显著相关性。综上所述，ALBI 分级可能作为接受 RFA 治疗的 HCC 患者预后预测的客观、可行的替代指标。
