Kaibori Masaki, Yoshii Kengo, Matsui Kosuke, Matsushima Hideyuki, Kosaka Hisashi, Yamamoto Hidekazu, Aoi Kazunori, Yamaguchi Takashi, Yoshida Katsunori, Hatanaka Takeshi, Hiraoka Atsushi, Tada Toshifumi, Kumada Takashi, Sekimoto Mitsugu
Department of Surgery, Kansai Medical University, Osaka 573-1191, Japan.
Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
Cancers (Basel). 2022 Oct 27;14(21):5292. doi: 10.3390/cancers14215292.
We developed and evaluated a modified albumin-bilirubin grade and α-fetoprotein (mALF) score, a nutritional and oncological assessment tool for patients with hepatocellular carcinoma (HCC) after surgical resection. Patients (n = 480) who underwent R0 resection between 2010 and 2020 were analyzed retrospectively. The mALF score assigned one point for a modified albumin-bilirubin (mALBI) grade 2b or 3 and one point for an α-fetoprotein (AFP) level ≥ 100 ng/mL. Patients were classified by mALF scores of 0 (mALBI grade 1/2a, AFP < 100 ng/mL), 1 (mALBI grade 2b/3 or AFP ≥ 100 ng/mL), or 2 (mALBI grade 2b/3, AFP ≥ 100 ng/mL) points. Liver reserve deteriorated and cancer progressed with increasing score. Postoperative complications (Clavien−Dindo classification ≥ 3) differed significantly among groups. The 5-year recurrence-free survival (RFS) rates were 34.8%, 11.2%, and 0.0% for 0, 1, and 2 points, respectively (1 or 2 versus 0 points, p < 0.001). The 5-year overall survival (OS) rates were 66.0%, 29.7%, and 17.8% for 0, 1, and 2 points, respectively (1 or 2 versus 0 points, p < 0.001). The mALF score was an independent prognostic predictor of RFS and OS. In HCC, the mALF score was effective for predicting postoperative complications and long-term survival.
我们开发并评估了一种改良的白蛋白-胆红素分级和甲胎蛋白（mALF）评分，这是一种用于肝细胞癌（HCC）手术切除术后患者的营养和肿瘤学评估工具。对2010年至2020年间接受R0切除的480例患者进行了回顾性分析。mALF评分中，改良白蛋白-胆红素（mALBI）分级为2b或3级计1分，甲胎蛋白（AFP）水平≥100 ng/mL计1分。患者根据mALF评分分为0分（mALBI分级1/2a，AFP<100 ng/mL）、1分（mALBI分级2b/3或AFP≥100 ng/mL）或2分（mALBI分级2b/3，AFP≥100 ng/mL）。随着评分增加，肝脏储备功能恶化且癌症进展。各组术后并发症（Clavien-Dindo分级≥3）差异显著。0分、1分和2分患者的5年无复发生存率（RFS）分别为34.8%、11.2%和0.0%（1或2分与0分相比，p<0.001）。0分、1分和2分患者的5年总生存率（OS）分别为66.0%、29.7%和17.8%（1或2分与0分相比，p<0.001）。mALF评分是RFS和OS的独立预后预测指标。在HCC中，mALF评分可有效预测术后并发症和长期生存。
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