白蛋白-胆红素评分在预测TACE治疗巨块型肝细胞癌后肝功能衰竭中的应用

The application of albumin-bilirubin score in predicting liver failure after transarterial chemoembolization for massive hepatocellular carcinoma

目的对比白蛋白-胆红素评分与Child-Pugh评分预测巨块型肝细胞癌患者TACE术后发生肝功能衰竭的能力。方法收集2017年1月至2021年9月南通大学附属肿瘤医院首次行TACE治疗的巨块型肝癌患者的临床资料。计算患者术前白蛋白-胆红素评分与Child-Pugh评分,分析不同的术前白蛋白-胆红素评分与Child-Pugh评分患者TACE术后肝功能衰竭的发生率。采用受试者工作特征曲线下面积(AUC)评价白蛋白-胆红素评分与Child-Pugh评分对TACE术后肝功能衰竭发生的预测能力。结果共纳入111例患者,36例(32.4%)发生TACE术后肝功能衰竭。白蛋白-胆红素评分为1级、2级和3级患者TACE术后肝功能衰竭的发生率分别为20.4%(11/54)、41.8%(23/55)和2/2,差异有统计学意义(P=0.013)。Child-Pugh评分为A级与B级患者TACE术后肝功能衰竭的发生率分别为28.9%(28/97)和8/14,差异有统计学意义(P=0.035)。Child-Pugh评分为A级但白蛋白-胆红素评分为1级和2级的患者肝功能衰竭发生率分别为20.4%(11/54)和39.5%(17/43),Child-Pugh评分为A级但白蛋白-胆红素评分为2级患者的TACE术后肝功能衰竭的发生率高于Child-Pugh评分为A级但白蛋白-胆红素评分为1级的患者,差异有统计学意义(P=0.039)。白蛋白-胆红素评分预测肝功能衰竭的AUC为0.80(95%CI:0.721~0.876),Child-Pugh评分的AUC为0.698(95%CI:0.604~0.782),差异有统计学意义(P=0.001)。结论白蛋白-胆红素评分对TACE术后肝功能衰竭发生的预测能力优于Child-Pugh评分。

Objective To compare the ability of albumin-bilirubin(ALBI)score and Child-Pugh(C-P)score in predicting liver failure in patients with massive hepatocellular carcinoma(HCC)after receiving transarterial chemoembolization(TACE).MethodsThe clinical data of patients with massive HCC,who received initial TACE at the Affiliated Tumor Hospital of Nantong University of China between January 2017 and September 2021,were retrospectively collected.The preoperative ALBI score and C-P score of all patients were calculated.The incidences of post-TACE liver failure in patients having different ALBI score and C-P score were analyzed.The area under the receiver operating characteristic curve(AUC)was used to evaluate the ability of ALBI score and the C-P score in predicting the occurrence of post-TACE liver failure.ResultsA total of 111 patients were enrolled in this study.Post-TACE liver failure occurred in 36 patients(32.4%).The incidences of post-TACE liver failure in patients having ALBI score of grade I,grade II and grade III were 20.4%(11/54),41.8%(23/55)and 2/2 respectively,the differences between each other among the three groups were statistically significant(P=0.013).The incidences of post-TACE liver failure in patients having C-P score of grade A and grade B were 28.9%(28/97)and 8/14 respectively,the difference between the two groups was statistically significant(P=0.035).Among the patients having C-P score of grade A,the incidences of post-TACE liver failure in the patients with ALBI score of grade I and the patients with ALBI score of grade II were 20.4%(11/54)and 39.5%(17/43)respectively;the incidence of post-TACE liver failure in the patients with ALBI score of grade II was higher than that in the patients having C-P score of grade A with ALBI score of grade I,the difference between the two was statistically significant(P=0.039).In predicting post-TACE liver failure occurrence the AUC of ALBI score was 0.80(95%CI=0.721-0.876),and the AUC of C-P score was 0.698(95%CI=0.604-0.782),the difference between the two was statistically significant(P=0.001).ConclusionIn predicting liver failure in patients with massive HCC after receiving TACE,ALBI score is superior to C-P score.