Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Liver Int. 2019 Sep;39(9):1704-1712. doi: 10.1111/liv.14194. Epub 2019 Jul 30.
BACKGROUND & AIMS: Transarterial chemoembolization (TACE) is a standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the outcome varied. This study aimed to develop a model to predict the outcome of TACE in HCC patients.
Consecutive 570 treatment-naïve BCLC stage B HCC patients undergoing TACE as the initial treatment from 2007 to 2016 were retrospectively enrolled. Factors associated with survival were analysed. Patients undergoing TACE from 2007 to 2011 constituted the training cohort (n = 293), while patients undergoing TACE from 2012 to 2016 constituted the validation cohort (n = 277). Homogeneity and corrected Akaike information criterion (AICc) were compared between each prognostic model.
A total of 1796 TACE sessions were performed for the 570 patients during the median follow-up period of 18.3 months. By multivariate analysis, beyond up-to-11 criteria (hazard ratio [HR] = 1.694, P < .001), alpha-foetoprotein >200 ng/mL (HR = 1.771, P < .001) and albumin-bilirubin (ALBI) grade 2 or 3 (HR = 1.817, P < .001) were independent predictors of overall survival (OS) in the training cohort. An ALBI-TAE model based on the three independent predictors of OS from the training cohort was developed to classify HCC patients into four subgroups. The performance of the ALBI-TAE model was superior to other prognostic models with lowest AICc values and highest homogeneity in both the training and validation datasets as well as the overall cohort.
Albumin-bilirubin grade is an important factor associated with survival in BCLC stage B HCC patients undergoing TACE. ALBI-TAE model can be applied to select patients who can get most benefit from TACE.
经动脉化疗栓塞术（TACE）是巴塞罗那临床肝癌（BCLC）B 期肝细胞癌（HCC）的标准治疗方法，但疗效不一。本研究旨在建立预测 HCC 患者 TACE 疗效的模型。
回顾性分析 2007 年至 2016 年间接受 TACE 作为初始治疗的 570 例治疗初治的 BCLC 期 B 型 HCC 患者。分析与生存相关的因素。2007 年至 2011 年接受 TACE 的患者为训练队列（n=293），2012 年至 2016 年接受 TACE 的患者为验证队列（n=277）。比较每个预测模型之间的同质性和校正 Akaike 信息准则（AICc）。
570 例患者中位随访 18.3 个月期间共进行了 1796 次 TACE 治疗。多因素分析显示，除了 up-to-11 标准（危险比[HR]1.694，P<.001）外，甲胎蛋白>200ng/mL（HR 1.771，P<.001）和白蛋白-胆红素（ALBI）分级 2 或 3（HR 1.817，P<.001）也是训练队列中总生存期（OS）的独立预测因素。基于训练队列中 OS 的三个独立预测因素，建立了一个基于 ALBI-TAE 模型的 HCC 患者分类模型，将患者分为四个亚组。ALBI-TAE 模型在训练和验证数据集以及整个队列中具有最低的 AICc 值和最高的同质性，其性能优于其他预测模型。
ALBI 分级是影响 BCLC 期 B 型 HCC 患者 TACE 疗效的重要因素。ALBI-TAE 模型可用于选择从 TACE 中获益最大的患者。
