4种评分系统预测肝细胞癌患者经肝动脉化疗栓塞术后肝衰竭的价值

Value of four scoring systems in predicting liver failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

目的:探讨Child-Pugh(CTP)、ALBI、MELD、MELD-Na评分预测肝细胞癌(hepatocellular carcinoma,HCC)经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗后并发慢性加急性肝衰竭(acute-on-chronic liver failture,ACLF)的价值。方法:回顾性分析2013月10月至2015年10月广西医科大学附属肿瘤医院接受首次TACE治疗的711例HCC患者的临床资料,采用Logistic回归分析及受试者工作特征(receiver operating characteristic,ROC)曲线评估4种评分模型预测ACLF的价值。结果:单因素、多因素分析结果均提示4种评分模型能独立预测TACE术后ACLF的发生(均P<0.05);ROC曲线分析显示,ALBI的受试者工作特征曲线下面积(area under curve,AUC)均显著高于其余三种评分的AUC(均P<0.001)。不同分型ACLF按4种评分模型的最佳截断(cut-off)值分组后,Child-Pugh评分>5.5分、ALBI>-2.29分、MELD>8.08分、MELD-Na>8.08分的患者ACLF总发病率和ACLF C型发病率均高于该4种评分低于cut-off值的患者(均P<0.001),而ACLF A型、ACLF B型的发病率两组间差异均无统计学意义(均P>0.05)。结论:Child-Pugh、ALBI、MELD及MELD-Na评分对TACE治疗后ACLF均有一定预测价值,ALBI预测价值最优。

Objective:To investigate the value of the Child-Pugh(CTP),ALBI,MELD,and MELD-Na scores in predicting acute-on-chronic liver failure(ACLF)in patients with hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE).Methods:Seven hundred and eleven patients with HCC who received their first TACE treatment at Guangxi Medical University Cancer Hospital between October 2013 and October 2015 were retrospectively analyzed.A Logistic regression analysis and receiver operating characteristic(ROC)curve were used to evaluate the efficacy of the four scoring models in predicting ACLF.Results:The results of the univariate and multivariate analysis showed that the four scoring models could independently predict the occurrence of ACLF after TACE.The ROC curve analysis showed that the area under the ROC curve(AUC)of ALBI was significantly higher than the other three scores(P<0.001).After different types of ACLF were grouped according to the best truncation(cut-off)values of the four scoring models,it was found that the incidence of ACLF total and ACLF C type in patients with a CTP score>5.5,ALBI>-2.29,MELD>8.08 and MELD-Na>8.08 was higher than those with scores lower than the cut-off values(P<0.001).However,there was no significant difference in the incidence of ACLF A type and ACLF B type between the two groups(P>0.001).Conclusions:The child-Pugh,ALBI,MELD,and MELD-Na scores have certain predictive value for ACLF after TACE treatment,with ALBI having the best predictive value.