Xiong Yiqi, Qiao Wenying, Mei Tingting, Li Kang, Jin Ronghua, Zhang Yonghong
Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, 100069, People's Republic of China.
National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
J Hepatocell Carcinoma. 2024 Jul 8;11:1375-1388. doi: 10.2147/JHC.S465962. eCollection 2024.
The aim of our study was to investigate the relationship between albumin-bilirubin (ALBI) grade and recurrence in patients who underwent TACE sequential ablation. We developed and validated a nomogram to predict low levels of ALBI patients' recurrence.
A total of 880 patients undergoing TACE combined ablation at Beijing Youan Hospital from January 2014 to December 2021 were retrospectively enrolled, including 415 patients with L-ALBI (≤-2.6) and 465 patients with high levels (>-2.6) of ALBI (H-ALBI). L-ALBI patients were randomized in a 7:3 ratio into the training cohort (N=289) and validation cohort (N=126). Multivariate Cox regression followed by random survival forest was carried out to identify independent risk factors for prediction nomogram construction. An examination of nomogram accuracy was performed using the C-index, receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA) curves. According to the nomogram, the patients were divided into low-risk, intermediate-risk, and high-risk groups. Kaplan-Meier (KM) curves were applied to compare the difference in recurrence-free survival (RFS) among the three groups.
The median RFS in L-ALBI patients was significantly longer than the H-ALBI patients (40.8m vs 20.1m, HR:1.71, 95% CI:1.44-2.04, P<0.0001). The nomogram was composed of five variables, such as age, Barcelona Clinic Liver Cancer (BCLC) stage, globulin, gamma-glutamyl transferase to lymphocyte ratio (GLR), and international normalized ratio (INR). The C-index (0.722 and 0.731) and 1-, 3-, and 5-year AUCs (0.725, 0.803, 0.870, and 0.764, 0.816, 0.798) of the training and validation cohorts proved the good predictive performance of the nomogram. Calibration curves and DCA curves demonstrated good consistency and good clinical utility. There were significant differences in RFS between the low-risk, intermediate-risk, and high-risk groups (P<0.0001).
L-ALBI Patients who underwent TACE combined ablation had better recurrence-free survival than patients with H-ALBI. The nomogram developed and validated in our study had good predictive ability in recurrence for L-ALBI patients.
本研究旨在探讨接受经动脉化疗栓塞（TACE）序贯消融治疗的患者中，白蛋白-胆红素（ALBI）分级与复发之间的关系。我们开发并验证了一种列线图，用于预测ALBI水平较低患者的复发情况。
回顾性纳入2014年1月至2021年12月在北京佑安医院接受TACE联合消融治疗的880例患者，其中包括415例低ALBI（≤-2.6）患者和465例高ALBI（>-2.6）（H-ALBI）患者。低ALBI患者按7:3的比例随机分为训练队列（N = 289）和验证队列（N = 126）。采用多变量Cox回归分析，随后进行随机生存森林分析，以确定用于构建预测列线图的独立危险因素。使用C指数、受试者工作特征（ROC）曲线、校准曲线和决策曲线分析（DCA）曲线对列线图的准确性进行评估。根据列线图，将患者分为低风险、中风险和高风险组。应用Kaplan-Meier（KM）曲线比较三组患者无复发生存期（RFS）的差异。
低ALBI患者的中位RFS显著长于高ALBI患者（40.8个月对20.1个月，HR：1.71，95%CI：1.44 - 2.04，P<0.0001）。列线图由年龄、巴塞罗那临床肝癌（BCLC）分期、球蛋白、γ-谷氨酰转移酶与淋巴细胞比值（GLR）和国际标准化比值（INR）等五个变量组成。训练队列和验证队列的C指数（分别为0.722和0.731）以及1年、3年和5年的AUC（分别为0.725、0.803、0.870和0.764、0.816、0.798）证明了列线图具有良好的预测性能。校准曲线和DCA曲线显示出良好的一致性和临床实用性。低风险、中风险和高风险组之间的RFS存在显著差异（P<0.0001）。
接受TACE联合消融治疗的低ALBI患者的无复发生存期优于高ALBI患者。我们研究中开发并验证的列线图对低ALBI患者的复发具有良好的预测能力。
