Xu Fei-Qi, Ye Tai-Wei, Wang Dong-Dong, Xie Ya-Ming, Zhang Kang-Jun, Cheng Jian, Xiao Zun-Qiang, Liu Si-Yu, Jiang Kai, Yao Wei-Feng, Shen Guo-Liang, Liu Jun-Wei, Zhang Cheng-Wu, Huang Dong-Sheng, Liang Lei
General Surgery, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Front Oncol. 2022 Jul 29;12:964614. doi: 10.3389/fonc.2022.964614. eCollection 2022.
Recently, the effectiveness of "textbook outcomes (TO)" in the evaluation of surgical quality has been recognized by more and more scholars. This study tended to examine the association between preoperative albumin-bilirubin (ALBI) grades and the incidence of achieving or not achieving TO (non-TO) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.
The patients were stratified into two groups: ALBI grade 1 (ALBI ≤ -2.60) and ALBI grade 2/3 (ALBI > -2.60). The characteristics of patients and the incidence of non-TO were compared. Multivariate analyses were performed to determine whether ALBI grade was independently associated with TO.
In total, 378 patients were enrolled, including 194 patients (51.3%) in the ALBI grade 1 group and 184 patients (48.7%) in the ALBI grade 2/3 group. In the whole cohort, 198 patients (52.4%) did not achieve TO, and the incidence of non-TO in the ALBI grade 2/3 group was obviously higher than that in the ALBI grade 1 group ( = 112, 60.9% . = 86, 44.3%, = 0.001). The multivariate analyses showed that ALBI grade 2/3 was an independent risk factor for non-TO (OR: 1.95, 95%CI: 1.30-2.94, = 0.023).
More than half (52.4%) of the patients with hepatocellular carcinoma did not achieve TO after laparoscopic hepatectomy, and preoperative ALBI grade 2/3 was significantly associated with non-TO. Improving the liver function reserve of patients before operation, thereby reducing the ALBI grade, may increase the probability for patients to reach TO and enable patients to benefit more from surgery.
近年来，“教科书式结局（TO）”在评估手术质量方面的有效性已得到越来越多学者的认可。本研究旨在探讨接受腹腔镜肝切除术的肝细胞癌（HCC）患者术前白蛋白-胆红素（ALBI）分级与达到或未达到TO（非TO）发生率之间的关联。
将患者分为两组：ALBI 1级（ALBI≤-2.60）和ALBI 2/3级（ALBI＞-2.60）。比较患者特征及非TO发生率。进行多因素分析以确定ALBI分级是否与TO独立相关。
共纳入378例患者，其中ALBI 1级组194例（51.3%），ALBI 2/3级组184例（48.7%）。在整个队列中，198例患者（52.4%）未达到TO，ALBI 2/3级组的非TO发生率明显高于ALBI 1级组（=112，60.9%。=86，44.3%，=0.001）。多因素分析显示，ALBI 2/3级是非TO的独立危险因素（OR：1.95，95%CI：1.30-2.94，=0.023）。
超过半数（52.4%）的肝细胞癌患者在腹腔镜肝切除术后未达到TO，术前ALBI 2/3级与非TO显著相关。改善患者术前肝功能储备，从而降低ALBI分级，可能会增加患者达到TO的概率，并使患者从手术中获益更多。
