Kim Kyu-Pyo, Kim Kang Mo, Ryoo Baek-Yeol, Choi Won-Mook, Cha Won Chul, Kang Mira, Sinn Dong Hyun, Goh Myung Ji, Kim Do Young, Lee Min Ji, Lim Subin, Kim DongKyu, Baek Kyoungdae, Kim Joohyun, Choi Eui Jun, Lee Doik, Kim Jung-Ae, Kim Ki-Hun
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Liver Cancer. 2024 Jun 14;13(6):610-628. doi: 10.1159/000539724. eCollection 2024 Dec.
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality globally, with treatment outcomes closely tied to liver function. This study evaluates the prognostic utility of the albumin-bilirubin (ALBI) score compared to the traditional Child-Pugh (CP) grading, leveraging real-world evidence from a large-scale, multi-center database.
The Liver Cancer IN Korea (LINK) research network, a multi-center initiative, retrospectively collected electronic health records from three academic hospitals in South Korea, encompassing HCC patients diagnosed between 2015 and 2020. Inclusion criteria mandated at least one HCC treatment and excluded patients with other primary cancer diagnoses. The study followed patients until death, the last visit, or June 2021, employing standardized data processing and rule-based algorithms for data consistency. The prognostic efficacy of ALBI scores and CP scores was compared through time-dependent receiver operating characteristic (ROC) curves and the inverse probability censoring weighting method.
From 25,248 newly diagnosed patients, 10,297 were included, with 65.82% having hepatitis B etiology and a mean follow-up of 27.49 months. Patients' classification by modified ALBI (mALBI) grade at diagnosis revealed: grade 1 (48.87%), 2a (20.50%), 2b (24.54%), and 3 (5.17%), with a minimal percentage missing (0.92%). Transarterial therapy (54.07%) and tyrosine kinase inhibitors (84.14% as the first-line systemic therapy) were predominant treatments. The ALBI score demonstrated greater prognostic efficacy than the CP score in long-term outcomes, with time-dependent area under the ROC curve analysis showing a score of 0.71 for ALBI versus 0.67 for CP at 60 months. Furthermore, higher mALBI grades were significantly associated with poorer survival outcomes, as indicated by both univariate and multivariate Cox proportional regression model analyses ( < 0.001).
The study confirmed the ALBI score's superior prognostic ability over the CP score, especially evident in long-term outcomes, suggesting a shift toward more nuanced liver function assessment tools in real-world clinical practice.
肝细胞癌（HCC）仍是全球癌症相关死亡的主要原因之一，其治疗结果与肝功能密切相关。本研究利用来自大规模多中心数据库的真实世界证据，评估了白蛋白-胆红素（ALBI）评分与传统Child-Pugh（CP）分级相比的预后效用。
韩国肝癌研究网络（LINK）是一项多中心倡议，回顾性收集了韩国三家学术医院2015年至2020年间诊断为HCC患者的电子健康记录。纳入标准要求至少接受过一次HCC治疗，并排除有其他原发性癌症诊断的患者。该研究对患者进行随访，直至死亡、最后一次就诊或2021年6月，采用标准化数据处理和基于规则的算法确保数据一致性。通过时间依赖性受试者操作特征（ROC）曲线和逆概率删失加权法比较ALBI评分和CP评分的预后效果。
在25248例新诊断患者中，纳入了10297例，其中65.82%为乙型肝炎病因，平均随访27.49个月。诊断时按改良ALBI（mALBI）分级对患者进行分类显示：1级（48.87%）、2a级（20.50%）、2b级（24.54%）和3级（5.17%），缺失百分比极小（0.92%）。经动脉治疗（54.07%）和酪氨酸激酶抑制剂（84.14%作为一线全身治疗）是主要治疗方法。在长期预后方面，ALBI评分显示出比CP评分更强的预后效果，ROC曲线分析的时间依赖性曲线下面积显示，60个月时ALBI评分为0.71，CP评分为0.67。此外，单因素和多因素Cox比例回归模型分析均表明，较高的mALBI分级与较差的生存结果显著相关（<0.001）。
该研究证实了ALBI评分在预后能力上优于CP评分，在长期预后中尤为明显，这表明在实际临床实践中应转向更细致的肝功能评估工具。
