Yang Haojie, Shen Shuang, Yang Yuting, Zhou Houping, Xiang Bangde
Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, 530021, China.
Department of Hepatobiliary Surgery, Changde Hospital (The First People's Hospital of Changde City), Xiangya School of Medicine, Central South University, Changde, Hunan, 415000, China.
BMC Cancer. 2025 May 12;25(1):855. doi: 10.1186/s12885-025-14240-7.
The Child-Pugh (CP) score is widely used to evaluate the severity of liver dysfunction in patients with hepatocellular carcinoma (HCC). Recently, both the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade have been raised to be objective measurement indexes of liver function which can sufficiently stratify HCC patient survival. In this study, we aim to compare the ability of albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade to predict outcomes in hepatitis B-Induced HCC after liver resection with curative intent.
Between April 2013 and April 2023, 1005 consecutive hepatitis B-Induced HCC patients who underwent liver resection were included in this study. The performance of PALBI and ALBI score in predicting long-term survival was evaluated.
The area under the ROC curve (AUC) of the PALBI(AUC:0.618) for predicting long-term survival was greater than that of the ALBI(AUC:0.522). In the multivariate analysis for OS, both the ALBI (HR: 1.246 95%CI: 1.029-1.508 P = 0.024) and PALBI (HR: 1.207 95%CI: 1.049-1.388 P = 0.009) scores were identified as independent predictors of OS in HCC patients. In the univariate analysis for DFS, the PALBI grade was also significantly associated with poor DFS (P = 0.041). In contrast, the ALBI grade was not found to be significantly associated with poor DFS (P = 0.414). Subgroup analysis also showed, among patients across each BCLC stage, the group with ALBI grade 1 had DFS similar to that of the group with ALBI grade 2 (both P > 0.05). However, the PALBI grade can differentiate each BCLC stages into three prognostic groups (all P < 0.05).
Compared to ALBI grade, the PALBI grade is more clinically feasible and has better prognostic ability regardless of the grade of BCLC stage.
Child-Pugh（CP）评分广泛用于评估肝细胞癌（HCC）患者肝功能障碍的严重程度。最近，白蛋白-胆红素（ALBI）分级和血小板-白蛋白-胆红素（PALBI）分级已成为肝功能的客观测量指标，可充分对HCC患者的生存进行分层。在本研究中，我们旨在比较白蛋白-胆红素（ALBI）分级和血小板-白蛋白-胆红素（PALBI）分级预测根治性肝切除术后乙型肝炎所致HCC患者预后的能力。
2013年4月至2023年4月，本研究纳入了1005例连续接受肝切除的乙型肝炎所致HCC患者。评估了PALBI和ALBI评分在预测长期生存方面的性能。
PALBI预测长期生存的ROC曲线下面积（AUC：0.618）大于ALBI（AUC：0.522）。在OS的多因素分析中，ALBI（HR：1.246，95%CI：1.029-1.508，P = 0.024）和PALBI（HR：1.207，95%CI：1.049-1.388，P = 0.009）评分均被确定为HCC患者OS的独立预测因素。在DFS的单因素分析中，PALBI分级也与较差的DFS显著相关（P = 0.041）。相比之下，未发现ALBI分级与较差的DFS显著相关（P = 0.414）。亚组分析还显示，在每个BCLC分期的患者中，ALBI 1级组的DFS与ALBI 2级组相似（均P > 0.05）。然而，PALBI分级可将每个BCLC分期分为三个预后组（均P < 0.05）。
与ALBI分级相比，PALBI分级在临床上更可行，并且无论BCLC分期如何，都具有更好的预后能力。
