白蛋白-胆红素分级在早期肝细胞癌射频消融中的预后意义

Prognostic significance of albumin-bilirubin grading in patients with early hepatocellular carcinoma after radiofrequency ablation treatment

目的探讨白蛋白-胆红素(ALBI)分级在接受肝动脉栓塞(TAE)联合射频消融(RFA)治疗的早期HCC患者中预后的意义。方法选择2006年4月至2010年12月接受TAE联合RFA治疗的HCC患者215例。定期随访,收集患者临床资料数据,Kaplan-Meier法绘制生存曲线,log-rank检验比较生存率,总生存期和无瘤生存期影响因素的单因素及多因素分析采用Cox回归分析。结果中位随访时间109个月,死亡100例,生存115例,1、2、3、5和10年生存率分别为99.5%、96.7%、92.1%、74%、57.6%。复发165例,1、2、3、5和10年复发率分别22.4%、39.3%、54.2%、69.7%、81.1%。ALBI 1级组患者生存率明显高于2级组患者,差异有显著统计学意义(χ2=9.07,P<0.01)。Cox多因素预后分析显示,年龄、ALBI分级、肿瘤直径是早期HCC患者消融术后长期生存的独立影响因素(P<0.05)。肿瘤直径是早期肝细胞癌患者消融术后无瘤生存期的独立影响因素(P<0.05)。结论ALBI分级、年龄、肿瘤直径是影响早期HCC RFA术后总生存期的独立危险因素,肿瘤直径是影响无瘤生存期的独立危险因素。

Objective To investigate the prognostic value of albumin-bilirubin(ALBI) grading in patients with early hepatocellular carcinoma(HCC) after transcatheter arterial embolization(TAE) combined with radiofrequency ablation(RFA). Methods A total of 215 patients with HCC,who received TAE combined with RFA during the period from April 2006 to December 2010,were enrolled in this study. The patients were regularly followed up, and the clinical data of all patients were collected. The survival curve was drawn by Kaplan-Meier method,and log-rank testing was used to compare the survival rate. Univariate analysis and Cox multivariate regression analysis were adopted to evaluate the overall survival(OS) and tumor-free survival(TFS).Results During the median follow-up period of 109 months,100 patients died and 115 patients survived. The1-,2-,3-,5-and 10-year survival rates were 99.5%,96.7%,92.1%,74% and 57.6%, respectively. A total of165 patients had a relapse. The 1-,2-,3-,5-and 10-year recurrence rates were 22.4%,39.3%,54.2%,69.7% and81.1%, respectively. The survival rate in ALBI grade Ⅰ group was significantly higher than that in ALBI grade Ⅱ group,the difference was statistically significant( χ2=9.07,P <0.01). Cox multivariate regression analysis indicated that age,ALBI grade and tumor diameter were the independent factors affecting the longterm survival of HCC patients after RFA(P<0.05),and the tumor diameter was an independent factor affecting TFS of patients with early HCC after RFA(P<0.05). Conclusion ALBI grade, age and tumor diameter are independent risk factors for OS of early HCC patients after RFA,and tumor diameter is an independent risk factor for TFS.(J Intervent Radiol, 2021, 30: 502-507)