Hiraoka Atsushi, Kumada Takashi, Tsuji Kunihiko, Takaguchi Koichi, Itobayashi Ei, Kariyama Kazuya, Ochi Hironori, Tajiri Kazuto, Hirooka Masashi, Shimada Noritomo, Ishikawa Toru, Tachi Yoshihiko, Tada Toshifumi, Toyoda Hidenori, Nouso Kazuhiro, Joko Kouji, Hiasa Yoichi, Michitaka Kojiro, Kudo Masatoshi
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
Liver Cancer. 2019 Mar;8(2):121-129. doi: 10.1159/000488778. Epub 2018 Jun 11.
BACKGROUND/AIM: The frequency of hepatocellular carcinoma (HCC) in patients with good hepatic reserve function has been increasing in Japan along with the progression of antiviral therapies and aging of the society. We evaluated the usefulness of modified albumin-bilirubin (ALBI) grade as a tool for assessment of hepatic reserve function.
MATERIALS/METHODS: We enrolled 6,649 naïve HCC patients treated from 2000 to 2017 and divided them into training (Ehime Prefecture group: E group, = 2,357) and validation (validation group: V group, = 4,292) cohorts. Child-Pugh classification and ALBI and modified ALBI (mALBI) grading were compared using with Japan Integrated Staging (JIS), ALBI-TNM (ALBI-T), and mALBI-T scores, which were calculated based on TNM stage and each assessment tool, retrospectively.
In the E group, Akaike's Information Criterion (AIC) and c-index values for mALBI-T (13,725.2/0.744) were better as compared to those of ALBI-T (13,772.6/0.733) and JIS score (13,874.7/0.720), with similar results observed in the V group (mALBI-T: 27,727.4/0.760; ALBI-T: 27,817.8/0.750; JIS: 27,807.5/0.748). Although there were some significant differences between the groups with regard to clinical background factors (age, etiology, tumor size, tumor number, treatment modalities), for all patients the AIC and c-index values of mALBI-T (45,327.1/0.755) were also better than those of ALBI-T (45,467.7/0.744) and JIS scores (45,555.8/0.739), indicating its superior stratification ability and prognostic predictive value in patients with HCC.
The detailed stratification ability of mALBI grade for hepatic reserve function is suitable for the recent trend of HCC patients, while mALBI-T may provide a more accurate predictive value than existing total staging scoring systems.
背景/目的：随着抗病毒治疗的进展以及社会老龄化，日本肝脏储备功能良好的肝细胞癌（HCC）患者的发病率一直在上升。我们评估了改良白蛋白-胆红素（ALBI）分级作为评估肝脏储备功能工具的实用性。
材料/方法：我们纳入了2000年至2017年期间接受治疗的6649例初治HCC患者，并将他们分为训练队列（爱媛县组：E组，n = 2357）和验证队列（验证组：V组，n = 4292）。回顾性地比较了Child-Pugh分类、ALBI和改良ALBI（mALBI）分级与日本综合分期（JIS）、ALBI-TNM（ALBI-T）和mALBI-T评分，后者是根据TNM分期和每种评估工具计算得出的。
在E组中，mALBI-T的赤池信息准则（AIC）和c指数值（13725.2/0.744）优于ALBI-T（13772.6/0.733）和JIS评分（13874.7/0.720），V组也观察到类似结果（mALBI-T：27727.4/0.760；ALBI-T：27817.8/0.750；JIS：27807.5/0.748）。尽管各组在临床背景因素（年龄、病因、肿瘤大小、肿瘤数量、治疗方式）方面存在一些显著差异，但对于所有患者，mALBI-T的AIC和c指数值（45327.1/0.755）也优于ALBI-T（45467.7/0.744）和JIS评分（45555.8/0.739），表明其在HCC患者中的分层能力和预后预测价值更优。
mALBI分级对肝脏储备功能的详细分层能力适合HCC患者的当前趋势，而mALBI-T可能比现有的总体分期评分系统提供更准确的预测价值。
