Wu Binquan, Hu Xiaosi, Jin Hao, Zhou Lei, Zhang Dengyong, Man Zhongran, Wang Yong, Yang Song, Pang Qing, Liu Huichun, Cui Peiyuan
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.
Medicine (Baltimore). 2019 Oct;98(43):e17394. doi: 10.1097/MD.0000000000017394.
Child-Pugh (CP) grade A patients with early stage hepatocellular carcinoma (HCC) are candidates for curative surgery, while some patients still have a poor outcome. The aim of this study was to investigate the prognostic values of 2 new evaluation models for liver function, named albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades, in CP grade A patients with HCC.In this retrospective cohort study, we reviewed 134 cases of CP grade A patients with hepatitis B-associated HCC who underwent radical surgery. ALBI and PALBI grades were calculated based on preoperative serologic examinations. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan-Meier curve and Cox regression. The prognostic performances of the models were estimated by using the concordance index (C-index).During a median follow-up time of 27 months, 27.6% (37/134) of patients died and 26.1% (35/134) experienced recurrence. Kaplan-Meier analyses showed that ALBI and PALBI grades were significantly associated with OS and RFS. Multivariate analyses further revealed that both ALBI and PALBI grades were independent predictors for survival. Furthermore, the prognostic values of the combination of tumor size with ALBI (C-index = 0.754, 95% confidence interval [CI]: 0.675-0.849) or with PALBI (C-index = 0.762, 95% CI: 0.664-0.844) may be comparable with both Barcelona Clinic Liver Cancer and Cancer of Liver Italian Program staging systems.The ALBI and PALBI grades, in particular the combination with tumor size, are effective models for discriminating survival in CP grade A patients with HCC.
Child-Pugh（CP）A级的早期肝细胞癌（HCC）患者是根治性手术的候选对象，但仍有部分患者预后较差。本研究旨在探讨两种新的肝功能评估模型，即白蛋白-胆红素（ALBI）分级和血小板-白蛋白-胆红素（PALBI）分级，对CP A级HCC患者的预后价值。在这项回顾性队列研究中，我们回顾了134例接受根治性手术的CP A级乙型肝炎相关HCC患者。根据术前血清学检查计算ALBI和PALBI分级。采用Kaplan-Meier曲线和Cox回归估计总生存期（OS）和无复发生存期（RFS）。通过一致性指数（C-index）评估模型的预后性能。在中位随访时间27个月期间，27.6%（37/134）的患者死亡，26.1%（35/134）的患者出现复发。Kaplan-Meier分析显示，ALBI和PALBI分级与OS和RFS显著相关。多变量分析进一步表明，ALBI和PALBI分级均为生存的独立预测因素。此外，肿瘤大小与ALBI（C-index = 0.754，95%置信区间[CI]：0.675-0.849）或与PALBI（C-index = 0.762，95% CI：0.664-0.844）联合的预后价值可能与巴塞罗那临床肝癌分期系统和意大利肝癌治疗方案分期系统相当。ALBI和PALBI分级，特别是与肿瘤大小联合，是区分CP A级HCC患者生存情况的有效模型。
