Ho Shu-Yein, Liu Po-Hong, Hsu Chia-Yang, Ko Chih-Chieh, Huang Yi-Hsiang, Su Chien-Wei, Hsia Cheng-Yuan, Tsai Ping-Hsing, Chou Shih-Jie, Lee Rheun-Chuan, Hou Ming-Chih, Huo Teh-Ia
Division of Gastroenterology and Hepatology, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC.
Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Hepatol Res. 2021 Nov;51(11):1129-1138. doi: 10.1111/hepr.13671. Epub 2021 Jun 5.
Liver functional reserve is a major prognostic determinant in patients with hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score is an objective method to assess the severity of cirrhosis in this setting. However, calculation of the ALBI score is complex and difficult to access in clinical practice. Recently, the EZ (easy)-ALBI score was proposed as an alternative biomarker of liver injury. We aimed to evaluate the prognostic role of the EZ-ALBI score in HCC from early to advanced stages.
A total of 3794 newly diagnosed HCC patients were prospectively enrolled and retrospectively analyzed. Independent prognostic predictors were determined by using the multivariate Cox proportional hazards model.
The EZ-ALBI score showed good correlation with the ALBI score (correlation coefficient, 0.965; p < 0.001). The correlation of the EZ-ALBI score was highly preserved in different Child-Turcotte-Pugh (CTP) classifications, treatment methods, and Barcelona Clinic Liver Cancer (BCLC) stages (correlation coefficients, 0.90-0.97). In the Cox multivariate analysis, age >65 years, male sex, serum α-fetoprotein >20 ng/ml, large or multiple tumors, total tumor volume >100 cm , vascular invasion or distant metastasis, ascites, poor performance status, EZ-ALBI grade 2 and 3, and noncurative treatments were independently associated with increased mortality (all p < 0.05). Moreover, EZ-ALBI grade can stratify long-term survival in patients with different CTP class, treatment strategy, and BCLC stage.
The EZ-ALBI score is an easy and feasible method to evaluate liver functional reserve. As a new prognostic biomarker in HCC, the predictive power of the EZ-ALBI grade is independent across different cancer stages and treatments.
肝功能储备是肝细胞癌（HCC）患者的主要预后决定因素。白蛋白-胆红素（ALBI）评分是评估这种情况下肝硬化严重程度的一种客观方法。然而，ALBI评分的计算复杂，在临床实践中难以获取。最近，EZ（简易）-ALBI评分被提议作为肝损伤的替代生物标志物。我们旨在评估EZ-ALBI评分在从早期到晚期HCC中的预后作用。
前瞻性纳入并回顾性分析了总共3794例新诊断的HCC患者。使用多变量Cox比例风险模型确定独立的预后预测因素。
EZ-ALBI评分与ALBI评分显示出良好的相关性（相关系数，0.965；p < 0.001）。EZ-ALBI评分的相关性在不同的Child-Turcotte-Pugh（CTP）分级、治疗方法和巴塞罗那临床肝癌（BCLC）分期中高度保持（相关系数，0.90 - 0.97）。在Cox多变量分析中，年龄>65岁、男性、血清甲胎蛋白>20 ng/ml、肿瘤大或多发、总肿瘤体积>100 cm、血管侵犯或远处转移、腹水、体能状态差、EZ-ALBI 2级和3级以及非根治性治疗与死亡率增加独立相关（所有p < 0.05）。此外，EZ-ALBI分级可对不同CTP分级、治疗策略和BCLC分期患者的长期生存进行分层。
EZ-ALBI评分是评估肝功能储备的一种简单可行的方法。作为HCC中的一种新的预后生物标志物，EZ-ALBI分级的预测能力在不同癌症分期和治疗中是独立的。
