白蛋白‐胆红素分级评估肝癌患者疗效和预后的研究进展

Research progress of albumin‑bilirubin grade in evaluating efficacy and prognosis of patients with hepatocellular carcinoma

肝细胞癌(HCC)是全球最常见的恶性肿瘤之一,而我国肝癌的发病率和死亡率均居世界首位。目前HCC的治疗手段多样,其中包括外科手术治疗(肝切除、肝移植)、局部消融治疗、介入治疗、放射治疗、免疫治疗、靶向治疗以及化疗等。但这些治疗措施对患者的肝功能均有一定要求,因为各类治疗均可能对肝癌患者的肝功能带来损伤,而部分肝癌患者发现时已处于晚期,本身即存在肝功能不全。因此,建立一个简单有效的可评估HCC患者肝功能的模型,以指导其临床疗效及预后是非常必要的。Child‐Pugh评分是目前临床上最常用的评估肝功能的方法,并被纳入BCLC分期系统指导HCC患者的临床治疗和评估预后。但其包含的5个指标,白蛋白、总胆红素、肝性脑病、腹水和凝血酶原时间未区分权重大小,且腹水、肝性脑病的主观性较强,此外白蛋白和腹水也是互相影响的因素,从而降低了评分的客观性和精确性。白蛋白‐胆红素(ALBI)分级是近年来提出的评估肝功能的新方法,仅包含白蛋白和胆红素两项客观指标,更简单客观。具体计算公式为ALBI=(log10胆红素×0.66)+(白蛋白×‐0.085),根据得分将HCC患者分为3个等级,ALBI 1级:ALBI≤‐2.60,ALBI 2级:‐2.60<ALBI≤‐1.39,ALBI 3级:ALBI>‐1.39,分级越高,肝功能越差。近年来,ALBI在评估HCC患者疗效和预后方面的作用已得到普遍验证。本文就ALBI分级分别在经肝移植、肝切除、肝射频消融、肝动脉化疗栓塞及靶向、免疫治疗的HCC患者疗效和预后评估中的应用,以及ALBI分级与其他分期系统联合评估HCC患者的预后等方面进行了综述。

Hepatocellular carcinoma(HCC)is one of the most common malignancy tumors and and the incidence and mortality of liver cancer in our country both rank first in the world.At present,the treatment methods for HCC are diverse,including surgical treatment(hepatectomy,liver transplantation),local ablation therapy,interventional therapy,radiation therapy,immunotherapy,targeted therapy,and chemotherapy.But these treatments both have requirements for the liver function of patients,because these treatments may cause damage to the liver function of patients with liver cancer more or less,and some patients with liver cancer are already at an advanced stage when they are discovered,and they already have liver damage.Therefore,it is very necessary to establish a simple and effective model that can evaluate the liver function of patients with liver cancer to guide its clinical efficacy and prognosis.Child⁃Pugh score is the most commonly used clinical method to evaluate liver function currently,and it has been already included in the BCLC staging system to guide the clinical treatment and prognosis of patients with liver cancer.However,it contains five indicators,albumin,total bilirubin,hepatic encephalopathy,ascites,and prothrombin time,they are not weighted,and ascites and hepatic encephalopathy are highly subjective.In addition,Albumin and ascites are also factors that affect each other,thereby reducing the objectivity and accuracy of the score.Albumin⁃bilirubin(ALBI)grade is a new method proposed in recent years to assess liver function.It only contains two objective indicators of albumin and bilirubin,which is simpler and more objective than Child⁃Pugh score.The specific calculation formula is ALBI=(log10 bilirubin×0.66)+(albumin×⁃0.085).According to the score,the patients with liver cancer are divided into three grades,ALBI grade 1:ALBI≤⁃2.60,ALBI grade 2:⁃2.60<ALBI≤⁃1.39,ALBI grade 3:ALBI>⁃1.39,the higher the grade,the worse the liver function.In recent years,the role of ALBI grade in evaluating the efficacy and prognosis of patients with liver cancer has been universally verified.This review summarizes the research progress of ALBI grade in evaluating efficacy and prognosis of patients with liver cancer through liver transplantation,liver resection,liver radiofrequency ablation,hepatic artery chemoembolization and targeted therapy,and immunotherapy,as well as the combination of ALBI grade and other staging systems to assess the prognosis of patients with liver cancer.