基于白蛋白-吲哚菁绿评分的巴塞罗那分期系统对肝细胞癌切除术预后的评估价值

Predictive value of Barcelona clinic liver cancer staging system combined with albumin-indocyanine green score in hepatectomy for hepatocellular carcinoma

目的探索基于白蛋白-吲哚菁绿(ALICE)评分的巴塞罗那临床肝癌(BCLC)分期系统(ALICE-BCLC)对肝细胞癌切除术预后的评估价值,并与基于Child-Pugh评分的BCLC分期系统(CP-BCLC)进行比较。方法回顾性分析2012年4月至2021年6月在浙江大学附属金华医院肝胆胰外科行肝切除术的311例肝细胞癌患者的临床资料,其中男性271例,女性40例,中位年龄59岁,年龄范围26~92岁。311例患者根据ALICE-BCLC分为2组:ALICE-BCLC 0级组(n=63)和ALICE-BCLC A级组(n=248)。依据CP-BCLC分为2组:CP-BCLC 0级组(n=58)和CP-BCLC A级组(n=253)。收集患者术前吲哚菁绿15 min滞留率、白蛋白等临床资料,计算各评分。采用门诊和电话相结合的方式进行随访。采用寿命法计算生存率,并采用Kaplan-Meier法绘制生存曲线。采用多因素Cox回归模型寻找影响预后的主要因素。选用加权Kappa比较两个分期系统的一致性。结果多因素分析结果显示,肿瘤最大径>5 cm、总胆红素>18 μmol/L、大范围肝切除、CP-BCLC A级和ALICE-BCLC A级是影响肝细胞癌患者根治性切除术后总体生存的独立危险因素(均P<0.05)。CP-BCLC 0级组与CP-BCLC A级组患者的中位生存时间分别为43.0和28.0个月,两组比较,差异有统计学意义(P=0.017)。ALICE-BCLC 0级组与ALICE-BCLC A级组患者的中位生存时间分别为41.4和28.1个月,两组比较,差异有统计学意义(P=0.035)。ALICE-BCLC和CP-BCLC的加权Kappa系数为0.949,具有极强的一致性(P<0.001)。结论 ALICE-BCLC对肝细胞癌切除术预后的预测价值较好,且与CP-BCLC具有相似的总体预后辨别能力。

Objective To study the predictive value of Barcelona clinic liver cancer(BCLC)staging system combined with albumin-indocyanine green(ALICE)score(ALICE-BCLC)in hepatectomy for hepatocellular carcinoma,and compare it with BCLC staging system combined with Child-Pugh score(CP-BCLC).Methods The clinical data of 311 patients with hepatocellular carcinoma who underwent hepatectomy at Jinhua Hospital Affiliated to Zhejiang University from April 2012 to June 2021 were analyzed retrospectively.There were 271 males and 40 females,with a median age of 59 years old(range 26 to 92 years old).These patients were divided into two groups based on the ALICE-BCLC:the ALICE-BCLC grade 0 group(n=63)and the ALICE-BCLC grade A group(n=248);and another two groups based on the CP-BCLC:the CP-BCLC grade 0 group(n=58)and the CP-BCLC grade A group(n=253).The clinical data,including indocyanine green retention rate at 15 min,and albumin were collected and the scores were calculated.Follow-up was conducted by combining outpatient visits with telephone calls.The survival rate was calculated by the life method,and survival curves were drawn by the Kaplan-Meier method.The multivariate Cox regression model was used to determine the main factors affecting prognosis.Weighted Kappa was used to compare consistency of the two staging systems.Results Multivariate analysis showed that a maximum tumor diameter>5 cm,total bilirubin>18μmol/L,major hepatectomy,CP-BCLC grade A and ALICE-BCLC grade A to be independent risk factors affecting overall survival of patients with hepatocellular carcinoma after liver resection with curative intent(all P<0.05).The median survival of patients in the CP-BCLC grade 0 group and the CP-BCLC grade A group were 43.0 and 28.0 months,respectively.There was a significant difference between the two groups(P=0.017).The median survival of patients in the ALICE-BCLC grade 0 group and the ALICE-BCLC grade A group were 41.4 and 28.1 months,respectively.There was a significant difference between the two groups(P=0.035).The weighted Kappa coefficient of ALICE-BCLC and CP-BCLC was 0.949,showing a strong consistency(P<0.001).Conclusion ALICE-BCLC showed a good predictive value for prognosis of hepatocellular carcinoma after liver resection,and it had a similar overall prognostic discrimination ability as CP-BCLC.