da Fonsecaa Leonardo G, de Melob Marina Acevedo Zarzar, da Silveirac Thamires Haick Martins, Yamamotod Victor Junji, Hashizumee Pedro Henrique Shimiti, Sabbagaf Jorge
Department of Oncology, ICESP - Instituto do Cancer do Estado de Sao Paulo, University of Sao Paulo School of Medicine, Sao Paulo, SP 01246-000, Brazil.
https://orcid.org/0000-0002-0216-3618.
Ecancermedicalscience. 2024 Aug 27;18:1748. doi: 10.3332/ecancer.2024.1748. eCollection 2024.
Hepatocellular carcinoma (HCC) is a lethal malignancy associated with cirrhosis and liver dysfunction. The aim of this study is to characterize a cohort of patients with advanced HCC according to liver function-related variables and evaluate the prognostic significance of Child-Pugh (CP) and albumin-bilirubin (ALBI) scores. A database of 406 HCC patients treated between 2009 and 2023 was retrospectively evaluated. Clinical and laboratory parameters were collected to classify patients into ALBI and CP scores. Survival was estimated using the Kaplan-Meier method and multivariate models were used to evaluate prognosis prediction. In this cohort, 337 (83%) patients were classified as CP-A, while 69 (17%) as CP-B. Additionally, according to ALBI score, 159 (39.2%) individuals were categorised as ALBI-1, 233 (57.4%) as ALBI-2 and 14 (3.4%) as ALBI-3. A statistically significant association between both classifications was observed ( < 0.001). CP and ALBI scores were independently associated with prognosis (Hazard ratio = 2.93 and 1.66, respectively), with better survival for patients with CP-A (versus B) and ALBI-1 (versus -2 and -3). ALBI score showed better predictive performance versus CP (c Harrell´s C index = 0.65 versus 0.62; = 0.008) and ALBI evolution during the first month of treatment was associated with overall survival. Additionally, ALBI score was able to define distinct prognostic subgroups within CP-A patients. In conclusion, liver function scores, such as ALBI and CP, have a clinically relevant prognostic role in patients with advanced HCC under systemic treatment. ALBI score is a more granular scoring scale than CP, and enables a more precise evaluation of patients with CP-A.
肝细胞癌（HCC）是一种与肝硬化和肝功能障碍相关的致命恶性肿瘤。本研究的目的是根据肝功能相关变量对一组晚期HCC患者进行特征描述，并评估Child-Pugh（CP）和白蛋白-胆红素（ALBI）评分的预后意义。对2009年至2023年期间接受治疗的406例HCC患者的数据库进行了回顾性评估。收集临床和实验室参数以将患者分类为ALBI和CP评分。使用Kaplan-Meier方法估计生存率，并使用多变量模型评估预后预测。在该队列中，337例（83%）患者被分类为CP-A，而69例（17%）为CP-B。此外，根据ALBI评分，159例（39.2%）个体被分类为ALBI-1，233例（57.4%）为ALBI-2，14例（3.4%）为ALBI-3。观察到两种分类之间存在统计学显著关联（<0.001）。CP和ALBI评分与预后独立相关（风险比分别为2.93和1.66），CP-A（与B相比）和ALBI-1（与-2和-3相比）的患者生存率更高。与CP相比，ALBI评分显示出更好的预测性能（c Harrell's C指数=0.65对0.62；=0.008），并且治疗第一个月期间的ALBI变化与总生存期相关。此外，ALBI评分能够在CP-A患者中定义不同的预后亚组。总之，肝功能评分，如ALBI和CP，在接受全身治疗的晚期HCC患者中具有临床相关的预后作用。ALBI评分是比CP更精细的评分量表，能够更精确地评估CP-A患者。
