Munir Muhammad Musaab, Endo Yutaka, Lima Henrique A, Alaimo Laura, Moazzam Zorays, Shaikh Chanza, Poultsides George A, Guglielmi Alfredo, Aldrighetti Luca, Weiss Matthew, Bauer Todd W, Alexandrescu Sorin, Kitago Minoru, Maithel Shishir K, Marques Hugo P, Martel Guillaume, Pulitano Carlo, Shen Feng, Cauchy François, Koerkamp Bas Groot, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, Stanford University, Stanford, CA, USA.
J Gastrointest Surg. 2023 Mar;27(3):544-554. doi: 10.1007/s11605-023-05578-z. Epub 2023 Jan 18.
The prognostic role of tumor burden score (TBS) relative to albumin-bilirubin (ALBI) grade among patients undergoing curative-intent resection of ICC has not been examined.
We identified patients who underwent curative-intent resection for ICC between 1990 and 2017 from a multi-institutional database. Multivariable analysis was performed to assess the effect of TBS relative to ALBI grade on both short- and long-term outcomes.
Among 724 patients, 360 (49.7%) patients had low TBS and low ALBI grade, 142 (19.6%) patients had low TBS and high ALBI grade, 138 (19.1%) patients had high TBS and low ALBI grade, and 84 patients (11.6%) had high TBS and high ALBI grade. Decreased tumor burden was associated with better long-term outcomes among patients with both low (5-year OS; low TBS vs. high TBS: 52.4% vs 21.4%; p < 0.001) and high ALBI grade (5-year OS; low TBS vs. high TBS: 40.7% vs 12.0%; p < 0.001). On multivariable analysis, higher ALBI grade was associated with greater odds of an extended hospital LOS (> 10 days) (OR 2.80, 95%CI 1.62-4.82; p < 0.001), perioperative transfusion (OR 2.04, 95%CI 1.25-3.36; p = 0.005), 90-day mortality (OR 2.56, 95%CI 1.12-5.81; p = 0.025), as well as a major complication (OR 1.99, 95%CI 1.13-3.49; p = 0.016) among patients with similar tumor burden. Of note, patients with high TBS and high ALBI grade had markedly worse overall survival compared with patients who had low TBS and low ALBI grade disease (HR 2.27; 95%CI 1.44-3.59; p < 0.001). Importantly, high TBS and high ALBI grade were strongly associated with both early recurrence (88.1%%) and 5-year risk of death (96.4%).
Both TBS (i.e., tumor morphology) and ALBI grade (i.e., hepatic function reserve) were strong predictors of outcomes among patients undergoing ICC resection. There was an interplay between TBS and ALBI grade relative to patient prognosis after hepatic resection of ICC with high ALBI grade predicting worse outcomes among ICC patients with different TBS.
在接受根治性切除的肝内胆管癌（ICC）患者中，肿瘤负荷评分（TBS）相对于白蛋白-胆红素（ALBI）分级的预后作用尚未得到研究。
我们从一个多机构数据库中识别出1990年至2017年间接受根治性切除的ICC患者。进行多变量分析以评估TBS相对于ALBI分级对短期和长期结局的影响。
在724例患者中，360例（49.7%）患者TBS低且ALBI分级低，142例（19.6%）患者TBS低且ALBI分级高，138例（19.1%）患者TBS高且ALBI分级低，84例（11.6%）患者TBS高且ALBI分级高。肿瘤负荷降低与TBS低（5年总生存率；低TBS与高TBS：52.4%对21.4%；p＜0.001）和ALBI分级高（5年总生存率；低TBS与高TBS：40.7%对12.0%；p＜0.001）的患者更好的长期结局相关。在多变量分析中，较高的ALBI分级与延长住院时间（＞10天）的更高几率相关（比值比[OR]2.80，95%置信区间[CI]1.62 - 4.82；p＜0.001）、围手术期输血（OR 2.04，95%CI 1.25 - 3.36；p = 0.005）、90天死亡率（OR 2.56，95%CI 1.12 - 5.81；p = 0.025）以及肿瘤负荷相似的患者中的主要并发症（OR 1.99，95%CI 1.13 - 3.49；p = 0.016）相关。值得注意的是，与TBS低且ALBI分级低的疾病患者相比，TBS高且ALBI分级高的患者总体生存率明显更差（风险比[HR]2.27；95%CI 1.44 - 3.59；p＜0.001）。重要的是，高TBS和高ALBI分级与早期复发（88.1%）和5年死亡风险（96.4%）均密切相关。
TBS（即肿瘤形态）和ALBI分级（即肝功能储备）都是接受ICC切除患者结局的强有力预测指标。在ICC肝切除术后，TBS和ALBI分级之间存在相互作用，相对于患者预后，高ALBI分级预示着不同TBS的ICC患者结局更差。
