Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital of Hallym University Medical Center, Chuncheon, Korea.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
Dig Dis Sci. 2018 Apr;63(4):1062-1071. doi: 10.1007/s10620-018-4934-6. Epub 2018 Feb 13.
Recently, albumin-bilirubin (ALBI) grade has been suggested as a better surrogate for hepatic functional reserve for patients with hepatocellular carcinoma (HCC).
We developed and validated a novel prediction model to predict outcome for HCC patients who underwent transcatheter arterial chemoembolization (TACE) as a first-line therapy.
From a multivariate Cox regression model for overall survival, five objective variables (ALBI grade), the Barcelona clinic liver cancer (BCLC) stage, response after the first TACE session, Alpha-fetoprotein level, and sex were chosen and the ABRAS score was developed from the derivation cohort (n = 476) and scored to generate an 8-point risk prediction model. The model's prognostic performance was assessed in the randomly assigned internal validation set (n = 475) and external validation set (n = 243).
The ALBI grade was able to stratify patient survival within the same Child-Pugh class. The time-dependent area under receiver operating characteristics curves (AUROCs) for overall survival at 1 and 3 years were 0.78 and 0.73 in the training set, 0.78 and 0.71 in the internal validation set, and 0.70 and 0.65 in the external validation set, respectively. When stratified by BCLC stage, ABRAS score at a cutoff point of more than 3, 4, and 5 for BCLC stage 0/A, B, and C could identify subset of patients with dismal prognosis.
ABRAS score was useful in estimating prognosis for patients who underwent TACE as a first-line therapy. This score can be useful in planning and guiding treatment strategies with TACE, which warrants prospective validation.
最近，白蛋白-胆红素（ALBI）分级被认为是肝细胞癌（HCC）患者肝储备功能的更好替代指标。
我们开发并验证了一种新的预测模型，用于预测接受经导管动脉化疗栓塞（TACE）作为一线治疗的 HCC 患者的预后。
从总生存的多变量 Cox 回归模型中，选择了五个客观变量（ALBI 分级）、巴塞罗那临床肝癌（BCLC）分期、首次 TACE 后反应、甲胎蛋白水平和性别，并从推导队列（n=476）中开发出 ABRAS 评分，并对其进行评分，生成一个 8 分的风险预测模型。该模型的预后性能在随机分配的内部验证集（n=475）和外部验证集（n=243）中进行了评估。
ALBI 分级能够在相同的 Child-Pugh 分级内分层患者的生存情况。在训练集中，1 年和 3 年的总生存时间的时间依赖性接受者操作特征曲线（AUROCs）分别为 0.78 和 0.73，内部验证集为 0.78 和 0.71，外部验证集为 0.70 和 0.65。当按 BCLC 分期分层时，ABRAS 评分在 BCLC 分期 0/A、B 和 C 的截断值超过 3、4 和 5 时，可以识别预后不良的亚组患者。
ABRAS 评分可用于评估接受 TACE 作为一线治疗的患者的预后。该评分可用于计划和指导 TACE 治疗策略，值得前瞻性验证。
