Hsu Wei-Fan, Hsu Shih-Chao, Chen Te-Hong, Lin Chien-Hung, Lin Ying-Chun, Chang Yu-Wei, Wang Hung-Wei, Liao Yu-Min, Lai Hsueh-Chou, Peng Cheng-Yuan
Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan.
Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404327, Taiwan.
Cancers (Basel). 2022 Oct 17;14(20):5083. doi: 10.3390/cancers14205083.
Albumin−bilirubin (ALBI) grade is an objective and reproducible model for evaluating overall survival (OS) in patients with hepatocellular carcinoma (HCC). However, the original ALBI grade was established for patients with Child−Pugh classes A−C. HCC patients with Child−Pugh class C or poor performance status (Barcelona Clinic Liver Cancer (BCLC) stage D) usually receive hospice care. Thus, optimized cutoffs for the ALBI grade for stratifying OS in HCC patients receiving anticancer therapy are pertinent for accurate prognostication. This study retrospectively enrolled 2116 patients with BCLC stages A−C HCC after the exclusion of those ineligible for receiving anticancer therapy. The modified ALBI (mALBI) grades were: an ALBI score ≤−3.02 for mALBI grade 1, an ALBI score >−3.02 to ≤−2.08 for mALBI grade 2, and an ALBI score >−2.08 for mALBI grade 3. The original ALBI and mALBI grades were independent predictors of OS in all the enrolled patients and those receiving transarterial chemoembolization. In patients receiving curative therapy (radiofrequency ablation and surgical resection), the mALBI grade (grade 2 vs. 1 and grade 3 vs. 2) was an independent predictor of OS. Original ALBI grade 2 vs. 1 was an independent predictor of OS but not ALBI grade 3 vs. 2. The mALBI model can differentiate between patients with early, intermediate, or advanced HCC who received anticancer therapy into three prognostic groups. External validation of the proposed mALBI grade is warranted.
白蛋白-胆红素（ALBI）分级是评估肝细胞癌（HCC）患者总生存期（OS）的一种客观且可重复的模型。然而，最初的ALBI分级是针对Child-Pugh A-C级的患者建立的。Child-Pugh C级或体能状态较差（巴塞罗那临床肝癌（BCLC）分期为D期）的HCC患者通常接受临终关怀。因此，对于接受抗癌治疗的HCC患者，优化ALBI分级的临界值以分层OS对于准确的预后评估至关重要。本研究回顾性纳入了2116例BCLC A-C期HCC患者，排除了那些不符合接受抗癌治疗条件的患者。改良的ALBI（mALBI）分级为：mALBI 1级的ALBI评分≤-3.02，mALBI 2级的ALBI评分＞-3.02至≤-2.08，mALBI 3级的ALBI评分＞-2.08。在所有纳入的患者以及接受经动脉化疗栓塞的患者中，原始的ALBI和mALBI分级都是OS的独立预测因素。在接受根治性治疗（射频消融和手术切除）的患者中，mALBI分级（2级与1级以及3级与2级）是OS的独立预测因素。原始ALBI分级2级与1级是OS的独立预测因素，但3级与2级不是。mALBI模型可以将接受抗癌治疗的早期、中期或晚期HCC患者区分为三个预后组。有必要对所提出的mALBI分级进行外部验证。
