Pan Jingying, Chen Shuochun, Tian Guo, Jiang Tianan
Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
Front Med (Lausanne). 2020 Nov 10;7:584871. doi: 10.3389/fmed.2020.584871. eCollection 2020.
Prognostic nutritional index (PNI) that was designed to assess the nutritional and immunological status of patients and albumin-bilirubin (ALBI) grades can be used as an assessment tool for hepatic function. Both nutritional and immunological statuses have been reported to be independent prognostic factors of patients with hepatocellular carcinoma (HCC). This study aimed to investigate whether PNI together with ALBI could be a better predictor in patients with early-stage HCC undergoing radiofrequency ablation (RFA). The information of 110 patients with newly diagnosed HCC within the Milan criteria receiving RFA as the initial therapy between 2014 and 2015 was retrospectively collected. Pretreatment PNI, ALBI, and PNI-ALBI grades were calculated. Overall survival (OS) and recurrence-free survival (RFS) were estimated by the Kaplan-Meier method, and multivariate analysis was used to identify prognostic factors. The 1-, 3-, and 5-years OS rates of patients were 80.0, 30.9, and 23.9%, respectively. Multivariate analysis showed that the tumor size [hazard ratio (HR) = 1.966, 95% confidence interval (CI) = 1.091-3.545, = 0.025], PNI grade (H = 2.558, 95% CI = 1.289-5.078, = 0.007), and PNI-ALBI grade (HR = 3.876, 95% CI = 1.729-8.690, = 0.001) were independent risk factors for OS, whereas only the elevated α-fetoprotein (HR = 1.732, 95% CI = 1.003-2.991, = 0.049) and the size of the tumor (HR = 1.640, 95% CI = 1.015-2.647, = 0.43) were independent predictors for better RFS. This study demonstrates that preoperative PNI-ALBI grade is a simple and useful predictor for OS in patients with early-stage HCC after RFA.
旨在评估患者营养和免疫状态的预后营养指数（PNI）以及白蛋白-胆红素（ALBI）分级可作为肝功能的评估工具。营养和免疫状态均已被报道为肝细胞癌（HCC）患者的独立预后因素。本研究旨在调查PNI联合ALBI是否能更好地预测接受射频消融（RFA）的早期HCC患者的预后。回顾性收集了2014年至2015年间110例符合米兰标准、以RFA作为初始治疗的新诊断HCC患者的信息。计算了治疗前的PNI、ALBI和PNI-ALBI分级。采用Kaplan-Meier法估计总生存期（OS）和无复发生存期（RFS），并进行多因素分析以确定预后因素。患者的1年、3年和5年OS率分别为80.0%、30.9%和23.9%。多因素分析显示，肿瘤大小[风险比（HR）=1.966，95%置信区间（CI）=1.091-3.545，P=0.025]、PNI分级（HR=2.558，95%CI=1.289-5.078，P=0.007）和PNI-ALBI分级（HR=3.876，95%CI=1.729-8.690，P=0.001）是OS的独立危险因素，而仅甲胎蛋白升高（HR=1.732，95%CI=1.003-2.991，P=0.049）和肿瘤大小（HR=1.640，95%CI=1.015-2.647，P=0.043）是RFS更好的独立预测因素。本研究表明，术前PNI-ALBI分级是RFA术后早期HCC患者OS的一个简单且有用的预测指标。
