Lin Po-Ting, Teng Wei, Jeng Wen-Juei, Chen Wei-Ting, Hsieh Yi-Chung, Huang Chien-Hao, Lui Kar-Wai, Hung Chen-Fu, Wang Ching-Ting, Chai Pei-Mei, Lin Chen-Chun, Lin Chun-Yen, Lin Shi-Ming, Sheen I-Shyan
Department of Gastroenterology and Hepatology, Linkou Branch, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan.
College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
Diagnostics (Basel). 2022 Mar 9;12(3):665. doi: 10.3390/diagnostics12030665.
Background and Aims: The Albumin-Bilirubin (ALBI) grade is a good index for liver function evaluation and is also associated with the outcomes of hepatocellular carcinoma patients receiving TACE. However, the correlation between the dynamic change to the ALBI score and clinical outcome is seldom discussed. Therefore, this study aimed to investigate the application of ALBI grade and dynamic change of ALBI grade (delta ALBI grade) after first TACE for prognosis prediction in HCC patients with chronic hepatitis C infection. Method: From January 2005 to December 2015, newly diagnosed naive chronic hepatitis C-hepatocellular carcinoma (CHC-HCC) patients who were treated with TACE as the initial treatment at the Chang Gung Memorial Hospital, Linkou Medical Center, were retrospectively recruited. The pre-treatment host factors, tumor status and noninvasive markers were collected. The Cox regression model was used to identify independent predictors of overall survival and tumor recurrence. Results: Among 613 treatment-naive CHC-HCC patients, 430 patients died after repeated TACE during a median follow-up of 26.9 months. Complete remission after repeated TACE occurred in 46.2% patients, and 208 patients (33.9%) had tumor recurrence, with a median recurrence-free interval of 8.5 months. In Cox regression analysis, ALBI grade II/III (aHR: 1.088, p = 0.035) and increased delta ALBI grade (aHR: 1.456, p = 0.029) were independent predictive factors for tumor recurrence. Furthermore, ALBI grade II/III (aHR: 1.451, p = 0.005) and increased delta ALBI grade during treatment (aHR: 1.436, p = 0.006) were predictive factors for mortality, while achieving complete response after repeated TACE (aHR: 0.373, p < 0.001) and anti-viral therapy (aHR: 0.580, p = 0.002) were protective factors for mortality. Conclusion: Both ALBI and delta ALBI grade are independent parameters to predict survival and tumor recurrence of CHC-HCC patients receiving TACE treatment.
白蛋白-胆红素（ALBI）分级是评估肝功能的良好指标，也与接受经动脉化疗栓塞术（TACE）的肝细胞癌患者的预后相关。然而，ALBI评分的动态变化与临床结局之间的相关性鲜有讨论。因此，本研究旨在探讨ALBI分级及首次TACE术后ALBI分级的动态变化（△ALBI分级）在慢性丙型肝炎感染的肝癌患者预后预测中的应用。方法：回顾性纳入2005年1月至2015年12月在林口长庚纪念医院医学中心首次接受TACE治疗的新诊断初治慢性丙型肝炎-肝细胞癌（CHC-HCC）患者。收集治疗前的宿主因素、肿瘤状态和非侵入性标志物。采用Cox回归模型确定总生存和肿瘤复发的独立预测因素。结果：在613例初治CHC-HCC患者中，430例患者在中位随访26.9个月期间经多次TACE治疗后死亡。多次TACE治疗后完全缓解的患者占46.2%，208例患者（33.9%）出现肿瘤复发，中位无复发生存期为8.5个月。在Cox回归分析中，ALBI II/III级（校正风险比：1.088，p = 0.035）和△ALBI分级升高（校正风险比：1.456，p = 0.029）是肿瘤复发的独立预测因素。此外，ALBI II/III级（校正风险比：1.451，p = 0.005）和治疗期间△ALBI分级升高（校正风险比：1.436，p = 0.006）是死亡的预测因素，而多次TACE治疗后达到完全缓解（校正风险比：0.373，p < 0.001）和抗病毒治疗（校正风险比：0.580，p = 0.002）是死亡的保护因素。结论：ALBI和△ALBI分级均是预测接受TACE治疗的CHC-HCC患者生存和肿瘤复发的独立参数。
