Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV road, Pathumwan, Bangkok, 10330, Thailand.
Center of Excellence in Liver Diseases, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
BMC Gastroenterol. 2022 Jun 14;22(1):295. doi: 10.1186/s12876-022-02366-y.
Heterogeneity of liver function and tumor burden in intermediate-stage hepatocellular carcinoma (HCC) results in different outcomes after transarterial chemoembolization (TACE). Easy albumin-bilirubin (EZ-ALBI), a simplified albumin-bilirubin (ALBI) score, has recently been proposed as a new prognostic score for HCC. This study aimed to validate the EZ-ALBI score and evaluate the impact of dynamic changes in patients with intermediate-stage HCC undergoing TACE.
All patients with HCC treated with TACE at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between January 2015 and December 2019 were prospectively enrolled. Intermediate-stage HCC was defined as Barcelona Clinic Liver Cancer (BCLC) stage B or unresectable single HCC with size > 5 cm in BCLC stage A. EZ-ALBI and ALBI scores were calculated and stratified into three different grades. Overall survival (OS) and prognostic factors were assessed using the Kaplan-Meier curve and Cox proportional hazard model. Decision analysis curves were used to evaluate the clinical utility of the predictive scores.
Among 672 patients with HCC treated with TACE, 166 patients with intermediate-stage HCC who met the eligibility criteria were enrolled. The median OS of all patients in the cohort was 21 months. A good correlation between the EZ-ALBI and ALBI scores was observed (correlation coefficient 1.000, p < 0.001). The baseline EZ-ALBI grades 1, 2, and 3 were 24.5%, 70%, and 5.5%, respectively. EZ-ALBI grade can stratify patients with significantly different prognoses (p = 0.002). Baseline EZ-ALBI grade 2, 3, and serum alpha-fetoprotein > 20 ng/ml were significantly associated with OS [hazard ratio (HR) 2.20 (95% confidence interval [CI] 1.24-3.88, p = 0.007), 3.26 (95% CI 1.24-8.57, p = 0.016), and 1.77 (95% CI 1.10-2.84, p = 0.018), respectively]. Following TACE, 42 (29.6%) patients had a worsening EZ-ALBI grade. However, the EZ-ALBI grade migration was not significantly correlated with OS. EZ-ALBI and ALBI score provided improved discriminatory ability (Harrell's concordance index 0.599 and 0.602, respectively) and better net benefit compared with Child-Turcotte-Pugh and Model for End-stage Liver Disease scores.
The baseline EZ-ALBI score demonstrated good predictive performance for survival and a strong correlation with conventional ALBI scores. Both the EZ-ALBI and ALBI scores outperformed other prognostic models in patients with intermediate-stage HCC receiving TACE. However, the dynamic change in the EZ-ALBI grade after TACE was not associated with postprocedural survival.
在中期肝细胞癌（HCC）中，肝功能和肿瘤负荷的异质性导致经动脉化疗栓塞（TACE）后的结果不同。简化的白蛋白-胆红素（ALBI）评分易白蛋白-胆红素（EZ-ALBI）评分最近被提出作为 HCC 的新预后评分。本研究旨在验证 EZ-ALBI 评分，并评估接受 TACE 的中期 HCC 患者的动态变化的影响。
所有在泰国曼谷朱拉隆功国王纪念医院接受 TACE 治疗的 HCC 患者均前瞻性入组。中期 HCC 定义为巴塞罗那临床肝癌（BCLC）B 期或不可切除的单个 HCC，BCLC A 期肿瘤大小＞5cm。计算 EZ-ALBI 和 ALBI 评分，并分为三个不同等级。使用 Kaplan-Meier 曲线和 Cox 比例风险模型评估总生存期（OS）和预后因素。决策分析曲线用于评估预测评分的临床效用。
在接受 TACE 治疗的 672 例 HCC 患者中，符合入选标准的 166 例中期 HCC 患者被纳入。队列中所有患者的中位 OS 为 21 个月。EZ-ALBI 和 ALBI 评分之间存在良好的相关性（相关系数 1.000，p<0.001）。基线 EZ-ALBI 等级 1、2 和 3 分别为 24.5%、70%和 5.5%。EZ-ALBI 分级可对具有显著不同预后的患者进行分层（p=0.002）。基线 EZ-ALBI 等级 2、3 和血清甲胎蛋白＞20ng/ml 与 OS 显著相关[风险比（HR）2.20（95%置信区间 [CI] 1.24-3.88，p=0.007）、3.26（95% CI 1.24-8.57，p=0.016）和 1.77（95% CI 1.10-2.84，p=0.018）]。在 TACE 后，有 42 例（29.6%）患者的 EZ-ALBI 分级恶化。然而，EZ-ALBI 分级迁移与 OS 无显著相关性。EZ-ALBI 和 ALBI 评分提供了更好的鉴别能力（Harrell 一致性指数分别为 0.599 和 0.602）和优于 Child-Turcotte-Pugh 和终末期肝病模型评分的净获益。
基线 EZ-ALBI 评分对生存具有良好的预测性能，与常规 ALBI 评分具有很强的相关性。EZ-ALBI 和 ALBI 评分在接受 TACE 的中期 HCC 患者中均优于其他预后模型。然而，TACE 后 EZ-ALBI 分级的动态变化与术后生存无关。
