Elshaarawy Omar, Alkhatib Alzhraa, Elhelbawy Mostafa, Gomaa Asmaa, Allam Naglaa, Alsebaey Ayman, Rewisha Eman, Waked Imam
Departemnt of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Menoufia 3511, Egypt.
World J Hepatol. 2019 Jun 27;11(6):542-552. doi: 10.4254/wjh.v11.i6.542.
An ideal staging system for hepatocellular carcinoma (HCC) should rely on the hepatic reserve function and tumor burden. With the improvement in diagnostic and treatment strategies for HCC, in addition to recent treatment of viral hepatitis, finding a suitable assessment tool for hepatic reserve has become mandatory.
To validate a recently proposed modified albumin-bilirubin-TNM (mALBI-T) grade as a prognostic model for patients with HCC in Egypt.
For patients diagnosed with HCC, Child-Turcotte-Pugh (CTP) score, Barcelona Clinic Liver Cancer (BCLC) stage, albumin-bilirubin (ALBI), plateltet-albumin-bilirubin (PALBI), ALBI-based BCLC, ALBI-T and mALBI-T grades were estimated. Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive. Overall survival and received treatments were determined. Survival data were analyzed.
A total of 1910 patients were included (mean age, 57 years; 1575 males). At presentation, 50.6% had CTP A, 36.1% had CTP B and 13.4 % had CTP C; 12% had ALBI grade 1, 62.3% had ALBI grade 2 and 24.7% had ALBI grade 3. Overall median survival was 13 mo; survival was better in patients with ALBI 1 than in those with ALBI 2 and 3 (28.6 14 and 5.8 mo, respectively, < 0.001). Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2, 3, 4 and 5 ( < 0.001). The modified ALBI-T showed better stratification and significant improvement in prediction of survival.
ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage. mALBI-T is a better prognostic model in patients with HCC.
理想的肝细胞癌（HCC）分期系统应基于肝脏储备功能和肿瘤负荷。随着HCC诊断和治疗策略的改进，以及近期对病毒性肝炎的治疗，寻找一种合适的肝脏储备评估工具已成为当务之急。
验证最近提出的改良白蛋白-胆红素-TNM（mALBI-T）分级作为埃及HCC患者的预后模型。
对诊断为HCC的患者评估Child-Turcotte-Pugh（CTP）评分、巴塞罗那临床肝癌（BCLC）分期、白蛋白-胆红素（ALBI）、血小板-白蛋白-胆红素（PALBI）、基于ALBI的BCLC、ALBI-T和mALBI-T分级。从诊断时起对患者进行随访，直至死亡日期或数据收集日期（如果患者仍存活）。确定总生存期和接受的治疗。对生存数据进行分析。
共纳入1910例患者（平均年龄57岁；男性1575例）。就诊时，50.6%为CTP A级，36.1%为CTP B级，13.4%为CTP C级；12%为ALBI 1级，62.3%为ALBI 2级，24.7%为ALBI 3级。总中位生存期为13个月；ALBI 1级患者的生存期优于ALBI 2级和3级患者（分别为28.6、14和5.8个月，P<0.001）。ALBI-T 0级和1级患者的生存期优于ALBI-T 2、3、4和5级患者（P<0.001）。改良的ALBI-T显示出更好的分层，在生存预测方面有显著改善。
ALBI-T分级是一种优越的预后工具，可筛选出肝脏储备和肿瘤分期较好的HCC患者。mALBI-T是HCC患者更好的预后模型。
