白蛋白-胆红素分级在确定极早期肝细胞癌患者预后中的作用。

The role of albumin-bilirubin grade in determining the outcomes of patients with very early-stage hepatocellular carcinoma.

作者信息

Chang Chung-Yu, Wei Cheng-Yi, Chen Ping-Hsien, Hou Ming-Chih, Chao Yee, Chau Gar-Yang, Lee Rheun-Chuan, Huang Yi-Hsiang, Su Yu-Hui, Wu Jaw-Ching, Su Chien-Wei

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2021 Feb 1;84(2):136-143. doi: 10.1097/JCMA.0000000000000482.

DOI:10.1097/JCMA.0000000000000482

PMID:33433133

Abstract

BACKGROUND

Patients with hepatocellular carcinoma (HCC) and with a single tumor <2 cm in size are classified as having Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC. We aimed to investigate the role of the albumin-bilirubin (ALBI) grade in predicting outcomes in patients with BCLC stage 0 HCC.

METHODS

We retrospectively enrolled patients with BCLC stage 0 HCC in Taipei Veterans General Hospital from 2007 to 2015. Prognostic factors were analyzed using a Cox proportional hazards model and propensity score matching (PSM) analysis.

RESULTS

There were 420 patients enrolled, including 207 with ALBI grade 1, and 213 with ALBI grade 2 or 3. After a median follow-up of 60.0 months (interquartile range, 37.2-84.6 months), 179 patients died. The cumulative 5-year overall survival (OS) rates were 80.6% in patients with ALBI grade 1 and 53.7% in those with ALBI grade 2 or 3, respectively (p < 0.001). Multivariate analysis showed that age >65 years, negative hepatitis B surface in serum, creatinine >1.0 mg/dL, platelet count ≤105/mm3, tumor size >1.5 cm, nonsurgical resection (SR) therapy, and higher ALBI grade were independent risk factors related to poor OS. Patients who underwent SR had a better OS and recurrence-free survival than those who received radiofrequency ablation, which was confirmed by a multivariate analysis and PSM analysis.

CONCLUSION

The ALBI grade can determine OS for patients with BCLC stage 0 HCC. SR can also provide a better outcome than nonsurgical treatment.

摘要

背景

肝细胞癌（HCC）且肿瘤单个、直径<2 cm的患者被归类为巴塞罗那临床肝癌（BCLC）0期HCC。我们旨在研究血清白蛋白-胆红素（ALBI）分级在预测BCLC 0期HCC患者预后中的作用。

方法

我们回顾性纳入了2007年至2015年台北荣民总医院的BCLC 0期HCC患者。使用Cox比例风险模型和倾向评分匹配（PSM）分析对预后因素进行分析。

结果

共纳入420例患者，其中207例为ALBI 1级，213例为ALBI 2级或3级。中位随访60.0个月（四分位间距，37.2 - 84.6个月）后，179例患者死亡。ALBI 1级患者的5年总生存率（OS）累计为80.6%，ALBI 2级或3级患者为53.7%（p < 0.001）。多因素分析显示，年龄>65岁、血清乙肝表面抗原阴性、肌酐>1.0 mg/dL、血小板计数≤105/mm3、肿瘤大小>1.5 cm、非手术切除（SR）治疗以及较高的ALBI分级是与OS不良相关的独立危险因素。接受SR治疗的患者比接受射频消融的患者有更好的OS和无复发生存率，这在多因素分析和PSM分析中得到证实。