Tokunaga Takayuki, Tanaka Motohiko, Tanaka Kentaro, Narahara Satoshi, Kawasaki Takeshi, Yoshimaru Yoko, Nagaoka Katsuya, Watanabe Takehisa, Tateyama Masakuni, Naoe Hideaki, Sasaki Yutaka, Tanaka Yasuhito
Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto City, Kumamoto, 860-8556, Japan.
Department of Health and Nutrition, Nagasaki International University, 2825-7 Huis Ten Bosch Town, Sasebo City, Nagasaki, 859-3298, Japan.
Int J Clin Oncol. 2021 May;26(5):922-932. doi: 10.1007/s10147-020-01835-2. Epub 2021 Mar 17.
Our aim is to evaluate the utility of liver function measured by modified albumin-bilirubin (mALBI) grade to predict eligibility for second-line therapies, including regorafenib and ramucirumab therapy, at initiation of sorafenib therapy for patients with hepatocellular carcinoma (HCC).
Participants in this retrospective, single-center study comprised 197 patients with sorafenib-treated HCC, Child-Pugh scores (CPs) 5-7 and performance status 0-1 treated between October 2009 and June 2019. The factors at initiation of sorafenib therapy, including mALBI grade and CPs, were analyzed with regard to second-line eligibility, regorafenib eligibility and ramucirumab eligibility, respectively.
Proportions of eligibility for second-line therapies, regorafenib therapy and ramucirumab therapy were 48.7%, 35.5% and 18.3%. Modified ALBI grades 1 and 2a were contributing factors for second-line eligibility (odd ratios [OR] 16.7 and 5.6; 95% CI 6.5-43.3 and 2.6-12.2), regorafenib therapy (OR 13.9 and 6.9; 95% CI 5.6-34.4 and 2.9-16.2), and ramucirumab therapy (OR 9.5 and 4.8; 95% CI 2.9-30.8 and 1.6-14.4), with grade 2b defined as reference. Patients with mALBI grade 1 and CPs 5 exhibited especially high proportion of eligibility for regorafenib therapy (70.5%). In patients with mALBI grade 2b, those with CPs 5 displayed higher proportion of eligibility for second-line therapy and ramucirumab therapy (100% and 50%) than those with CPs 6 (31.8% and 11.4%).
Modified ALBI grade in combination with CPs at the initiation of sorafenib therapy would be useful to predict eligibility for second-line therapies.
我们的目的是评估改良白蛋白-胆红素（mALBI）分级所测定的肝功能在预测肝细胞癌（HCC）患者开始索拉非尼治疗时接受二线治疗（包括瑞戈非尼和雷莫西尤单抗治疗）的适用性。
这项回顾性单中心研究的参与者包括197例接受索拉非尼治疗的HCC患者，其Child-Pugh评分（CPs）为5 - 7，体能状态为0 - 1，于2009年10月至2019年6月期间接受治疗。分别分析索拉非尼治疗开始时的因素，包括mALBI分级和CPs，与二线治疗适用性、瑞戈非尼适用性和雷莫西尤单抗适用性的关系。
二线治疗、瑞戈非尼治疗和雷莫西尤单抗治疗的适用性比例分别为48.7%、35.5%和18.3%。改良ALBI 1级和2a级是二线治疗适用性的影响因素（比值比[OR]分别为16.7和5.6；95%置信区间[CI]为6.5 - 43.3和2.6 - 12.2）、瑞戈非尼治疗（OR分别为13.9和6.9；95% CI为5.6 - 34.4和2.9 - 16.2）以及雷莫西尤单抗治疗（OR分别为9.5和4.8；95% CI为2.9 - 30.8和1.6 - 14.4），以2b级作为参照。mALBI 1级且CPs为5的患者接受瑞戈非尼治疗的适用性比例特别高（70.5%）。在mALBI 2b级患者中，CPs为5的患者接受二线治疗和雷莫西尤单抗治疗的适用性比例（分别为100%和50%）高于CPs为6的患者（分别为31.8%和11.4%）。
索拉非尼治疗开始时的改良ALBI分级联合CPs有助于预测二线治疗的适用性。
