Bannangkoon Kittipitch, Hongsakul Keerati, Tubtawee Teeravut, Ina Natee
Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
Cancers (Basel). 2024 Oct 17;16(20):3503. doi: 10.3390/cancers16203503.
This study aimed to investigate the prognostic value of preoperative myosteatosis and the albumin-bilirubin (ALBI) grade in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) and develop a robust prognostic score based on these factors.
Patients with HCC who underwent TACE between January 2009 and December 2020 were included. Multivariate Cox regression analysis identified prognostic factors. CT-based body composition parameters were acquired from baseline abdominal CT images at the level of the third lumbar vertebra. A prognostic score (Myo-ALBI) was developed based on the presence of preoperative myosteatosis and the ALBI grade, and its prognostic value was evaluated.
Of 446 patients, 63% were male, and the mean age was 62.4 years. Preoperative myosteatosis was present in 41.5% of patients. The BCLC stages were mostly B (67.9%). Multivariate analysis shows that preoperative myosteatosis, ALBI grade 2, and ALBI grade 3 were independent prognostic factors. The Myo-ALBI grade was incorporated into a prognostic model, including alpha-fetoprotein and up-to-seven criteria, to generate a nomogram. The C-index of the nomogram based on the Myo-ALBI grade (0.743) was significantly higher than the non-Myo-ALBI nomogram (0.677), the up-to-seven criteria (0.653), the ALBI grade (0.616), and the Child-Pugh class (0.573) (all < 0.05). The t-ROC curve for the nomogram was consistently superior to the other models throughout the observation period in all patients and the BCLC-B subgroup.
The combination of preoperative CT-derived myosteatosis and ALBI grade enhances prognostication for patients with unresectable HCC undergoing TACE. The Myo-ALBI nomogram constructed in this study could support individualized prognosis prediction, assisting in treatment decision-making for HCC patients.
本研究旨在探讨术前肌少脂变和白蛋白-胆红素（ALBI）分级对接受经动脉化疗栓塞术（TACE）的肝细胞癌（HCC）患者的预后价值，并基于这些因素建立一个可靠的预后评分系统。
纳入2009年1月至2020年12月期间接受TACE的HCC患者。多因素Cox回归分析确定预后因素。基于CT的身体成分参数从第三腰椎水平的基线腹部CT图像中获取。根据术前肌少脂变的存在情况和ALBI分级建立预后评分（Myo-ALBI），并评估其预后价值。
446例患者中，63%为男性，平均年龄为62.4岁。41.5%的患者存在术前肌少脂变。BCLC分期大多为B期（67.9%）。多因素分析显示，术前肌少脂变、ALBI 2级和ALBI 3级是独立的预后因素。将Myo-ALBI分级纳入一个预后模型，该模型包括甲胎蛋白和七项标准，以生成列线图。基于Myo-ALBI分级的列线图的C指数（0.743）显著高于非Myo-ALBI列线图（0.677）、七项标准（0.653）、ALBI分级（0.616）和Child-Pugh分级（0.573）（均P<0.05）。在所有患者和BCLC-B亚组的整个观察期内，列线图的t-ROC曲线始终优于其他模型。
术前CT衍生的肌少脂变和ALBI分级相结合可增强对接受TACE的不可切除HCC患者的预后评估。本研究构建的Myo-ALBI列线图可支持个体化预后预测，辅助HCC患者的治疗决策。
