Lin Yan-Ting, Lin Po-Ting, Lin Chen-Chun, Wu Tsung-Han, Liu Li-Tong, Su Chung-Wei, Teng Wei, Tsai Chun-Yi, Huang Chien-Hao, Chen Wei-Ting, Chan Kun-Ming, Hsu Chao-Wei, Lin Chun-Yen, Lin Shi-Ming, Chien Rong-Nan
Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
College of Medicine, Chang-Gung University Taoyuan, Taiwan.
Am J Cancer Res. 2023 Aug 15;13(8):3618-3628. eCollection 2023.
Hepatocellular carcinoma (HCC) is associated with high mortality, especially in Asian populations where chronic HBV infection is a major cause. Accurate prediction of mortality can assist clinical decision-making. We aim to (i) compare the predicting ability of Barcelona Clinic Liver Cancer classification (BCLC) stage, neutrophil-to-lymphocyte ratio (NLR), and Albumin-Bilirubin (ALBI) score in predicting short-term mortality (one- and two-year) and (ii) develop a novel model with improved accuracy compared to the conventional models. This study enrolled 298 consecutive HCC patients from our hepatology department. The prognostic values for mortality were assessed by area under the receiver operating characteristic curve (AUROC) analysis. A novel model was established and internally validated using 5-fold cross-validation, followed by external validation in a cohort of 100 patients. The primary etiology of cirrhosis was hepatitis B virus (HBV), with 81.2% of HCC patients having preserved liver function. Significant differences were observed in hemoglobin (Hb) and serum albumin levels, which reflect patients' nutrition status, between patients who survived for one year and those who died. BCLC exhibited superior predictive accuracy compared to NLR but had borderline superiority to the ALBI score. Therefore, a novel model incorporating BCLC, Hb, and serum albumin was developed, internally and externally validated, as well as subgroup sensitivity analysis. The model exhibited significantly higher predictive accuracy for one- and two-year mortality than conventional prognostic predictors, with AUROC values of 0.841 and 0.805, respectively. The novel "BCLC-Nutrition Model", which incorporates BCLC, Hb, and serum albumin, may provide improved predictive accuracy for short-term mortality in HCC patients compared to commonly used prognostic scores. This emphasizes the importance of nutrition in the management of HCC patients.
肝细胞癌（HCC）与高死亡率相关，尤其是在慢性乙肝病毒感染为主要病因的亚洲人群中。准确预测死亡率有助于临床决策。我们旨在：（i）比较巴塞罗那临床肝癌分期（BCLC）、中性粒细胞与淋巴细胞比值（NLR）和白蛋白-胆红素（ALBI）评分在预测短期死亡率（1年和2年）方面的预测能力；（ii）开发一种比传统模型准确性更高的新模型。本研究纳入了来自我们肝病科的298例连续的HCC患者。通过受试者工作特征曲线下面积（AUROC）分析评估死亡率的预后价值。建立了一个新模型，并使用5折交叉验证进行内部验证，随后在100例患者的队列中进行外部验证。肝硬化的主要病因是乙肝病毒（HBV），81.2%的HCC患者肝功能良好。在存活1年和死亡的患者之间，反映患者营养状况的血红蛋白（Hb）和血清白蛋白水平存在显著差异。与NLR相比，BCLC表现出更高的预测准确性，但与ALBI评分相比优势不明显。因此，开发了一种纳入BCLC、Hb和血清白蛋白的新模型，并进行了内部和外部验证以及亚组敏感性分析。该模型对1年和2年死亡率的预测准确性显著高于传统预后预测指标，AUROC值分别为0.841和0.805。与常用的预后评分相比，纳入BCLC、Hb和血清白蛋白的新型“BCLC-营养模型”可能为HCC患者的短期死亡率提供更高的预测准确性。这强调了营养在HCC患者管理中的重要性。
