基于简化白蛋白-胆红素评分的多中心验证研究:一项预测肝细胞肝癌切除术后并发症和生存时间的新模型

A multicentre validation study based on easy albumin-bilirubin score:a new model for predicting postoperative complications and survival of hepatocellular carcinoma

目的探索简化白蛋白-胆红素(easy albumin-bilirubin,EZ-ALBI)评分对肝细胞肝癌(hepatocellular carcinoma,HCC)切除术后短期并发症和长期预后的预测价值。方法回顾性收集2014年8月至2018年8月期间于5个医疗中心(四川大学华西医院、四川省医学科学院·四川省人民医院、内江市第一人民医院、宜宾市第二人民医院和乐山市人民医院)行手术治疗的1822例HCC患者的临床病理数据,采用非条件logistic回归和Cox比例风险回归模型分别探索EZ-ALBI评分对短期并发症和长期预后的影响。结果EZ-ALBI分级为2级的患者有更高的术后严重并发症(Clavein-Dindo分级>2级)发生率(P=0.001)、术后肝功能衰竭发生率(P=0.040)、围手术期输血率(P<0.001)和90 d死亡率(P<0.001)以及更高比例的住院时间>10 d(P<0.001)。EZ-ALBI分级为1级患者的1、3、5年累积生存率分别为85.5%、67.0%和58.7%,EZ-ALBI分级为2级患者分别为72.7%、51.1%和39.8%。多因素Cox比例风险回归模型结果表明,EZ-ALBI评分分级2级[HR=1.24,95%CI(1.04,1.48),P=0.015]患者的总生存情况更差。结论EZ-ALBI评分是预测HCC术后并发症和总生存的一种简便可行的方法。

Objective To evaluate the prognostic value of the easy albumin-bilirubin(EZ-ALBI)score for postoperative complications and long-term prognosis of hepatocellular carcinoma(HCC)patients.Methods The data on consecutive 1822 HCC patients who underwent hepatectomy were obtained and retrospectively analyzed from five medical centers,including West China Hospital,Sichuan Provincial People’s Hospital,The First People’s Hospital of Neijiang City,The Second People’s Hospital of Yibin City,and People’s Hospital of Leshan City.Non-conditional logistic and Cox proportional hazards regression were used to evaluate the aspect on the postoperative complications and long-term prognosis.Results The patients in EZ-ALBI grade 2 had higher incidences of severe complication(Clavein-Dindo classification>2,P=0.001),post-hepatectomy liver failure(P=0.040),length of stay>10 d(P<0.001),perioperative transfusion(P<0.001),and 90 d mortality(P<0.001).The 1-,3-and 5-year cumulative survival rates in EZ-ALBI grade 1 group were 85.5%,67.0%,and 58.7%while in EZ-ALBI grade 2 group were 72.7%,51.1%,and 39.8%.Multivariate Cox proportional hazards regression manifested that patients in EZ-ALBI grade 2 had a significantly worse overall survival[HR=1.24,95%CI(1.04,1.48),P=0.015].Conclusion The EZ-ALBI score is an easy and feasible classifying method to predict postoperative complications and survival of HCC.