白蛋白-胆红素分级在肝外胆管癌患者死亡率中的预后作用。

The prognostic role of albumin-bilirubin grade in the mortality of extrahepatic cholangiocarcinoma patients.

作者信息

Dayyan Fatemeh, Zamani Farhad, Ajdarkosh Hossein, Khoonsari Mahmoodreza, Faraji Amirhossein, Nikkhah Mehdi, Nourian Akram, Safarnezhad Tameshkel Fahimeh, Sobhrakhshankhah Elham

机构信息

Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran.

出版信息

BMC Gastroenterol. 2025 May 19;25(1):383. doi: 10.1186/s12876-025-03979-9.

DOI:10.1186/s12876-025-03979-9

PMID:40389833

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12090579/

Abstract

OBJECTIVE

Cholangiocarcinoma (CCA) has a low survival rate of 5-17%, despite advancements in diagnosis and treatment. Liver function impacts disease prognosis, and the albumin-bilirubin (ALBI) score is a new assessment model for this purpose. While research suggests a correlation between ALBI score, liver failure and mortality in intrahepatic CCA (iCCA), predicting outcomes for extrahepatic CCA (eCCA) is challenging. Our objective was to assess the prognostic role of ALBI grade in predicting overall survival of eCCA patients.

METHODS

Patients with diagnosis of eCCA who had visited Firuzgar Hospital from 2015 to 2019 were consecutively included in the study. These individuals had previously undergone Endoscopic Ultrasound-Guided Fine Needle Aspiration (EUS-FNA) or ERCP brush cytology followed by surgery. Exclusion criteria were patients with benign bile duct strictures, prior biliary tract surgery, concurrent liver disease impacting liver tests, inadequate data, or inconsistent monitoring. Clinical data of patients were collected to calculate ALBI score which was subsequently divided into three distinct grades (grade 1: ≤-2.60, grade 2: > -2.60 to ≤ - 1.39, grade 3: >-1.39). Kaplan-Meier analysis and Cox regression model were used to analyze overall survival, 1-, 3- and 5-year survival and parameters affecting patient survival.

RESULTS

In this study, 80 patients with diagnosis of eCCA with a median age of 67 (58.25-74) years (67.5% male) who visited Firuzgar Hospital from 2015 to 2019 were included. The average survival time of patients was 13.9 ± 16.4 months, and the 1-year, 3-year, and 5-year survival rates of patients were 36.6%, 27.1%, and 15.8%, respectively. The results showed that ALBI grade, Aspartate Aminotransferase (AST), white blood cell (WBC) and international normalized ratio (INR) have significant effects on the survival of patients (all P < 0.05). Based on the results of Cox regression, the risk of mortality due to CCA in patients with ALBI grade 3 (HR = 1.87, P = 0.0111), AST > 82.5 (HR = 1.90, P = 0.0091), WBC > 7.70 × 10/L (HR = 2.46, P = 0.0004), and INR > 1.08 (HR = 1.78, P = 0.0202) increases significantly.

CONCLUSION

We showed that ALBI grade, AST > 82.5 units/L, and INR > 1.08 can be used as predictive factors of survival in cholangiocarcinoma patients.

摘要

目的

尽管在诊断和治疗方面取得了进展，但胆管癌（CCA）的生存率仍较低，为5%-17%。肝功能会影响疾病预后，而白蛋白-胆红素（ALBI）评分是用于此目的的一种新评估模型。虽然研究表明ALBI评分、肝衰竭与肝内胆管癌（iCCA）的死亡率之间存在相关性，但预测肝外胆管癌（eCCA）的预后具有挑战性。我们的目的是评估ALBI分级在预测eCCA患者总生存期方面的预后作用。

方法

2015年至2019年期间到菲鲁兹加尔医院就诊且诊断为eCCA的患者连续纳入本研究。这些患者此前均接受过超声内镜引导下细针穿刺活检（EUS-FNA）或内镜逆行胰胆管造影（ERCP）刷检细胞学检查，随后接受了手术。排除标准为患有良性胆管狭窄的患者、既往有胆道手术史、并发影响肝功能检查的肝脏疾病、数据不充分或监测不一致的患者。收集患者的临床数据以计算ALBI评分，随后将其分为三个不同等级（1级：≤-2.60，2级：>-2.60至≤-1.39，3级：>-1.39）。采用Kaplan-Meier分析和Cox回归模型分析总生存期、1年、3年和5年生存率以及影响患者生存的参数。

结果

本研究纳入了2015年至2019年期间到菲鲁兹加尔医院就诊、诊断为eCCA的80例患者，中位年龄为67（58.25-74）岁（男性占67.5%）。患者的平均生存时间为13.9±16.4个月，患者的1年、3年和5年生存率分别为36.6%、27.1%和15.8%。结果表明，ALBI分级、天冬氨酸转氨酶（AST）、白细胞（WBC）和国际标准化比值（INR）对患者的生存有显著影响（均P<0.05）。根据Cox回归结果，ALBI 3级患者（HR=1.87，P=0.0111）、AST>82.5（HR=1.90，P=0.0091）、WBC>7.70×10/L（HR=2.46，P=0.0004）和INR>1.08（HR=1.78，P=0.0202）的CCA患者死亡风险显著增加。