Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan.
Ann Surg Oncol. 2021 Oct;28(11):6223-6235. doi: 10.1245/s10434-021-09593-9. Epub 2021 Jan 23.
No study has clarified the clinical significance of albumin-bilirubin (ALBI) grade in a large cohort of pancreatic cancer patients.
A total of 1006 consecutive patients diagnosed with pancreatic cancer and deemed eligible for surgical resection were analyzed. The ALBI score was calculated as: ALBI score = (log bilirubin [µmol/L] × 0.66) + (albumin [g/L] × - 0.0852). ALBI grade was assigned as grade 1, 2a, 2b, and 3. ALBI grade 1 was assigned to the ALBI low group (N = 566), and grades 2a, 2b, and 3 to the ALBI high group (N = 440).
The primary lesion could not be resected in 129 patients. Among all patients, overall survival (OS) was significantly worse in the ALBI high group than in the ALBI low group (P = 0.024). Overall, 877 patients underwent pancreatectomy. In these patients, the ALBI high group was associated with high CA19-9 level (P < 0.001), lower morbidity rate (P < 0.001), and pancreatic head tumor (P = 0.001). Patients' OS after resection was significantly worse in the ALBI high group than in the ALBI low group (P < 0.001). Cox proportional hazard analysis revealed ALBI grade as an independent predictor for prognosis (hazard ratio, 1.33; P = 0.015). Even in the CA19-9 negative patients, OS was significantly worse in the ALBI high group than in the ALBI low group (P = 0.046).
The ALBI grade is a clinically useful predictor for prognosis in pancreatic cancer patients.
尚无研究在大型胰腺癌患者队列中阐明白蛋白-胆红素（ALBI）分级的临床意义。
共分析了 1006 例连续诊断为胰腺癌且符合手术切除条件的患者。ALBI 评分的计算方法为：ALBI 评分=（log 胆红素[µmol/L]×0.66）+（白蛋白[g/L]×-0.0852）。ALBI 分级为 1 级、2a 级、2b 级和 3 级。将 ALBI 分级 1 级归为 ALBI 低组（N=566），将 2a 级、2b 级和 3 级归为 ALBI 高组（N=440）。
129 例患者原发灶无法切除。在所有患者中，ALBI 高组的总生存期（OS）明显短于 ALBI 低组（P=0.024）。共有 877 例患者接受了胰切除术。在这些患者中，ALBI 高组与 CA19-9 水平升高（P<0.001）、较低的发病率（P<0.001）和胰头肿瘤（P=0.001）相关。与 ALBI 低组相比，ALBI 高组患者的术后 OS 明显较差（P<0.001）。Cox 比例风险分析显示，ALBI 分级是预后的独立预测因素（风险比，1.33；P=0.015）。即使在 CA19-9 阴性患者中，ALBI 高组的 OS 也明显短于 ALBI 低组（P=0.046）。
ALBI 分级是预测胰腺癌患者预后的一种临床有用的指标。
