Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University.
Department of Hepatobiliary Pancreatic Surgery, Chengdu Second People's Hospital, Chengdu, China.
Medicine (Baltimore). 2021 Mar 19;100(11):e24476. doi: 10.1097/MD.0000000000024476.
The platelet-albumin-bilirubin (PALBI) grade plays critical role in evaluating liver function. However, the change of PALBI grade from the preoperative to postoperative period in predicting patient outcomes after hepatectomy remains unclear.A total of 489 HCC patients who underwent hepatectomy in West China Hospital between January, 2010 and June, 2016 were analyzed retrospectively.ΔPALBI grade was calculated by PALBI grade at the first postoperative month - preoperative PALBI grade.ΔPALBI >0 was considered as stable; otherwise, worse PALBI grade was considered. Kaplan- Meier method and Cox proportional hazard regression analyses were performed for survival analysis. Prognostic model was constructed by nomogram method.Three hundred forty two patients and 147 patients were classified into training group and validation group, respectively. In the training group, results from Cox model suggested that worse PALBI grade (HR 1.328, 95% CI 1.010-1.746, P = .042), tumor size (HR 1.460, 95% CI 1.058-2.015, P = .021), microvascular invasion (MVI, HR 1.802, 95% CI 1.205-2.695, P < .001), and high alpha-fetoprotein level (AFP, HR 1.364, 95% CI 1.044-1.781, P = .023) negatively influenced postoperative recurrence. Similarly, worse PALBI grade (HR 1.403, 95% CI 1.020-1.930, P = .038), tumor size (HR 1.708, 95% CI 1.157-2.520, P = .007), MVI (HR 1.914, 95% CI 1.375-2.663, P < .001), and presence of cirrhosis (HR 1.773, 95% CI 1.226-2.564, P = .002) had negatively impacts on overall survival. Patients with worse PALBI grade had worse recurrence free (RFS) and overall survival (OS). The prognostic model incorporating the change of PALBI grade constructed in training group and tested in the validation group could perform well in predicting the outcomes.Postoperative change of PALBI grade was independently risk factor related with prognosis. Prognostic model incorporating the change of PALBI grade might be a useful index to predict the prognosis of HCC patients following hepatectomy.
血小板-白蛋白-胆红素（PALBI）分级在评估肝功能方面起着关键作用。然而，肝切除术后从术前到术后 PALBI 分级的变化对预测患者预后的影响尚不清楚。
本研究回顾性分析了 2010 年 1 月至 2016 年 6 月在华西医院接受肝切除术的 489 例 HCC 患者。ΔPALBI 级通过术后第 1 个月的 PALBI 级与术前 PALBI 级的差值计算。ΔPALBI＞0 为稳定；否则，更差的 PALBI 级被认为是不稳定的。采用 Kaplan-Meier 法和 Cox 比例风险回归分析进行生存分析。通过列线图法构建预后模型。将 342 例患者和 147 例患者分别分为训练组和验证组。在训练组中，Cox 模型的结果表明，更差的 PALBI 级（HR 1.328，95%CI 1.010-1.746，P=0.042）、肿瘤大小（HR 1.460，95%CI 1.058-2.015，P=0.021）、微血管侵犯（MVI，HR 1.802，95%CI 1.205-2.695，P＜0.001）和高甲胎蛋白水平（AFP，HR 1.364，95%CI 1.044-1.781，P=0.023）对术后复发有负面影响。同样，更差的 PALBI 级（HR 1.403，95%CI 1.020-1.930，P=0.038）、肿瘤大小（HR 1.708，95%CI 1.157-2.520，P=0.007）、MVI（HR 1.914，95%CI 1.375-2.663，P＜0.001）和肝硬化（HR 1.773，95%CI 1.226-2.564，P=0.002）对总生存期也有负面影响。PALBI 分级较差的患者复发无（RFS）和总生存（OS）较差。在训练组中构建并在验证组中测试的包含 PALBI 分级变化的预后模型在预测结果方面表现良好。
术后 PALBI 分级的变化是与预后相关的独立危险因素。纳入 PALBI 分级变化的预后模型可能是预测 HCC 患者肝切除术后预后的有用指标。
