Szor Daniel Jose, Pereira Marina Alessandra, Ramos Marcus Fernando Kodama Pertille, Tustumi Francisco, Dias Andre Roncon, Zilberstein Bruno, Ribeiro Ulysses
Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil.
World J Gastrointest Surg. 2023 Jun 27;15(6):1125-1137. doi: 10.4240/wjgs.v15.i6.1125.
Albumin-bilirubin (ALBI) score is an indicator of liver dysfunction and is useful for predicting prognosis of hepatocellular carcinomas. Currently, this liver function index has been used to predict prognosis in other neoplasms. However, the significance of ALBI score in gastric cancer (GC) after radical resection has not been elucidated.
To evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.
Patients with GC who underwent curative intended gastrectomy were retrospectively evaluated from our prospective database. ALBI score was calculated as follows: (log10 bilirubin × 0.660) + (albumin × -0.085). The receiver operating characteristic curve with area under the curve (AUC) was plotted to evaluate the ability of ALBI score in predicting recurrence or death. The optimal cutoff value was determined by maximizing Youden's index, and patients were divided into low and high-ALBI groups. The Kaplan-Meier curve was used to analyze the survival, and the log-rank test was used for comparison between groups.
A total of 361 patients (235 males) were enrolled. The median ALBI value for the entire cohort was -2.89 (IQR -3.13; -2.59). The AUC for ALBI score was 0.617 (95%CI: 0.556-0.673, < 0.001), and the cutoff value was -2.82. Accordingly, 211 (58.4%) patients were classified as low-ALBI group and 150 (41.6%) as high-ALBI group. Older age ( = 0.005), lower hemoglobin level ( < 0.001), American Society of Anesthesiologists classification III/IV ( = 0.001), and D1 lymphadenectomy = 0.003) were more frequent in the high-ALBI group. There was no difference between both groups in terms of Lauren histological type, depth of tumor invasion (pT), presence of lymph node metastasis (pN), and pathologic (pTNM) stage. Major postoperative complication, and mortality at 30 and 90 days were higher in the high-ALBI patients. In the survival analysis, the high-ALBI group had worse disease-free survival (DFS) and overall survival (OS) compared to those with low-ALBI ( < 0.001). When stratified by pTNM, the difference between ALBI groups was maintained in stage I/II and stage III CG for DFS ( < 0.001 and = 0.021, respectively); and for OS ( < 0.001 and = 0.063, respectively). In multivariate analysis, total gastrectomy, advanced pT stage, presence of lymph node metastasis and high-ALBI were independent factors associated with worse survival.
The preoperative ALBI score is able to predict the outcomes of patients with GC, where high-ALBI patients have worse prognosis. Also, ALBI score allows risk stratification of patients within the same pTNM stages, and represents an independent risk factor associated with survival.
白蛋白-胆红素（ALBI）评分是肝功能不全的一个指标，有助于预测肝细胞癌的预后。目前，该肝功能指标已用于预测其他肿瘤的预后。然而，ALBI评分在胃癌（GC）根治性切除术后的意义尚未阐明。
评估接受根治性治疗的GC患者术前ALBI状态的预后价值。
从我们的前瞻性数据库中对接受根治性意向性胃切除术的GC患者进行回顾性评估。ALBI评分计算如下：（log10胆红素×0.660）+（白蛋白× -0.085）。绘制曲线下面积（AUC）的受试者工作特征曲线，以评估ALBI评分预测复发或死亡的能力。通过最大化约登指数确定最佳临界值，并将患者分为低ALBI组和高ALBI组。采用Kaplan-Meier曲线分析生存率，采用对数秩检验进行组间比较。
共纳入361例患者（235例男性）。整个队列的ALBI中位数为-2.89（IQR -3.13；-2.59）。ALBI评分的AUC为0.617（95%CI：0.556 - 0.673，P < 0.001），临界值为-2.82。因此，211例（58.4%）患者被分类为低ALBI组，150例（41.6%）为高ALBI组。高ALBI组中年龄较大（P = 0.005）、血红蛋白水平较低（P < 0.001）、美国麻醉医师协会分级III/IV（P = 0.001）和D1淋巴结清扫（P = 0.003）更为常见。两组在劳伦组织学类型、肿瘤浸润深度（pT）、淋巴结转移情况（pN）和病理（pTNM）分期方面无差异。高ALBI患者术后主要并发症以及30天和90天死亡率更高。在生存分析中，与低ALBI患者相比，高ALBI组的无病生存期（DFS）和总生存期（OS）更差（P < 0.001）。按pTNM分层时，I/II期和III期GC的ALBI组之间在DFS方面的差异保持存在（分别为P < 0.001和P = 当分层由pTNM，ALBI组之间的差异保持在阶段I / II和阶段III CG DFS（<0.001和= 0.021，分别）；和OS（<0.001和= 0.063，分别）。在多变量分析中，全胃切除术、晚期pT分期、淋巴结转移的存在和高ALBI是与较差生存相关的独立因素。
术前ALBI评分能够预测GC患者的预后，高ALBI患者预后更差。此外，ALBI评分可对处于相同pTNM分期的患者进行风险分层，并且是与生存相关的独立危险因素。 021）；对于OS（分别为P < 0.001和P = 0.063）。在多变量分析中，全胃切除术、晚期pT分期、淋巴结转移的存在和高ALBI是与较差生存相关的独立因素。
术前ALBI评分能够预测GC患者的预后，高ALBI患者预后更差。此外，ALBI评分可对处于相同pTNM分期的患者进行风险分层，并且是与生存相关的独立危险因素。
