Gong Baocuo, Wang Xuewen, Guo Wanting, Yang Hongyi, Shi Yanhong, Chen Yaying, Gao Simiao, Chen Jialin, Liu Lifang, Lu Linbin, Chen Xiong
Department of Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, 350025, People's Republic of China.
Department of Oncology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, Fujian, 350025, People's Republic of China.
J Hepatocell Carcinoma. 2023 Aug 11;10:1341-1351. doi: 10.2147/JHC.S415770. eCollection 2023.
Transarterial chemoembolization (TACE) is the recommended first-line treatment for intermediate-stage Hepatocellular carcinoma (HCC) patients. However, predicting the survival of HCC patients receiving TACE remains challenging.
In this retrospective study, we analyzed a total of 1805 HCC patients who received TACE. The patients were randomly divided into a training set (n = 1264) and a validation set (n = 541). We examined various prognostic factors within the training set and developed a simple ALFP (ALBI grade, AFP, and Prothrombin time) score, which was subsequently validated using the independent validation set.
Our multivariate analysis revealed that baseline ALBI grade 2 or 3, AFP ≥ 100 ng/mL, and PT > 13.1 s were independent unfavorable prognostic factors for HCC patients receiving TACE (p < 0.05). Based on these findings, we constructed the ALFP score, which assigns 1 point each for ALBI grade 2 or 3, AFP ≥ 100 ng/mL, and PT > 13.1 s. The score has a range of 0 to 3, and higher scores are associated with poorer outcomes. The median overall survival (OS) varied significantly among different ALFP score groups, both in the training set and the validation set (p < 0.001). We further examined the ALFP score in subgroups based on tumor diameter and the number of intrahepatic lesions. In each subgroup, higher ALFP scores were consistently associated with lower OS (p < 0.05).
Our study confirms the prognostic value of the ALFP score in predicting the survival of HCC patients undergoing TACE. The score incorporates easily obtainable baseline parameters and provides a simple and practical tool for risk stratification and treatment decision-making in HCC patients.
经动脉化疗栓塞术（TACE）是中期肝细胞癌（HCC）患者推荐的一线治疗方法。然而，预测接受TACE治疗的HCC患者的生存情况仍然具有挑战性。
在这项回顾性研究中，我们分析了总共1805例接受TACE治疗的HCC患者。患者被随机分为训练集（n = 1264）和验证集（n = 541）。我们在训练集中检查了各种预后因素，并制定了一个简单的ALFP（白蛋白-胆红素分级、甲胎蛋白和凝血酶原时间）评分，随后使用独立验证集对其进行验证。
我们的多因素分析显示，基线白蛋白-胆红素分级为2级或3级、甲胎蛋白≥100 ng/mL以及凝血酶原时间>13.1秒是接受TACE治疗的HCC患者独立的不良预后因素（p<0.05）。基于这些发现，我们构建了ALFP评分，白蛋白-胆红素分级为2级或3级、甲胎蛋白≥100 ng/mL以及凝血酶原时间>13.1秒各计1分。该评分范围为0至3分，分数越高，预后越差。在训练集和验证集中，不同ALFP评分组的中位总生存期（OS）差异显著（p<0.001）。我们进一步在基于肿瘤直径和肝内病灶数量的亚组中检查了ALFP评分。在每个亚组中，较高的ALFP评分始终与较低的OS相关（p<0.05）。
我们的研究证实了ALFP评分在预测接受TACE治疗的HCC患者生存情况方面的预后价值。该评分纳入了易于获得的基线参数，为HCC患者的风险分层和治疗决策提供了一个简单实用的工具。
