Modified Child-Pugh grade vs albumin-bilirubin grade for predicting prognosis of hepatocellular carcinoma patients after hepatectomy

BACKGROUND Hepatectomy is the main treatment for patients with hepatocellular carcinoma(HCC)and it has a high possibility for long-term cure potential.But the postoperative mortality and recurrence rates remain high.Since the long-term prognosis of HCC patients is strongly linked to liver function,preoperative assessment of liver function is very important for HCC patients.AIM To compare the predictive power of the modified Child-Pugh(MCP)and albumin-bilirubin(ALBI)grades for the long-term outcome of HCC.METHODS From January 2010 to June 2017,a total of 204 patients with HCC who underwent surgery at the Second Affiliated Hospital of Chongqing Medical University were enrolled in this retrospective study.Multivariate Cox regression analysis was used to determine the independent predictive factors of survival and relapse.The area under the curve(AUC)was used to evaluate the discriminative performance of the MCP grade and ALBI grade to predict the postoperative overall survival(OS)time and recurrence-free survival(RFS)time.RESULTS The median OS and RFS times were 44.0 mo(range:22.0-74.0 mo)and 22.0 mo(range:5.0-45.0 mo),respectively.The median OS and RFS times of MCP grades 1,2,and 3 patients were 60.0,39.0,and 18.0 mo(P<0.001)and 36.0,15.0,and 7.0 mo(P<0.001),respectively.The median OS and RFS times of ALBI grades 1,2,and 3 patients were 56.0,26.0,and 6.0 mo(P<0.001)and 25.0,10.0,and 3.0 mo(P=0.003),respectively.Both the MCP and ALBI grades were more accurate than the Child-Pugh grade for predicting long-term prognosis.Further analysis demonstrated that for both predicting OS and RFS,the MCP grade performed better than the ALBI grade(AUC:0.642 vs 0.605 for OS;0.659 vs 0.594 for RFS).CONCLUSION The MCP grade is more accurate than the ALBI grade for predicting long-term outcome of patients with HCC.

Nomogram based on albumin-bilirubin grade to predict outcome of the patients with hepatitis C virus-related hepatocellular carcinoma after microwave ablation

Objective:To construct a nomogram based on the albumin-bilirubin(ALBI)grade to provide prognostic value for hepatitis C virus(HCV)-related hepatocellular carcinoma(HCC)patients who underwent ultrasound-guided percutaneous microwave ablation(US-PMWA).Methods:From April 2005 to January 2018,183 treatment-naIve patients with 251 HCV-related HCCs according to the Milan criteria received US-PMWA subsequently.The overall survival(OS)and recurrence-free survival(RFS)were compared between groups classified by ALBI grade.Cox proportional hazard regression model based on risk factors for survival and recurrence was used to construct the nomogram.Results:The cumulative OS rates at 1-,3-,5-and 10-year were 97.7%,73.6%,54.5%and 34.5%,respectively.Stratified according to ALBI grade,the 1-,3-,and 5-year OS in the ALBI grade 1 group and grade 2 group were 99.2%,92.4%,77.9% and 97.7%,52.3%,38.6%,respectively,with significant statistical difference(P<0.001).No significant statistical difference was detected in the1-,3-,and 5-year RFS rates in the ALBI grade 1 group and grade 2 group(P=0.220).The major complication rate was 1.6%.Multivariate analysis results showed age,α-fetoprotein level,tumor number,platelet count,location,Child-Turcotte-Pugh(CTP)and ALBI grade were associated with OS,which generated the nomograms.Internal validation with 1000 bootstrapped sample sets had good concordance index of 0.769(95%CI 0.699-0.839)in OS.Conclusions:This nomogram based on ALBI grade was a visualization risk model,which could provide personalized prediction of long-term outcomes for HCV-related HCC patients after US-PMWA.

Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

BACKGROUND Modified albumin-bilirubin(mALBI)grade has been established as a survival determinant in hepatocellular carcinoma(HCC)patients who receive locoregional and targeted therapies.AIM To investigate whether mALBI could predict survival in unresectable HCC(uHCC)patients who were treated with atezolizumab plus bevacizumab(AB).METHODS A single-center,retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June 2023.An association between mALBI and patient survival was determined using Cox proportional hazards analysis.RESULTS Of the 83 patients,67 patients(80.7%)were male with the mean age of 60.6 years.Among them,22 patients(26.5%)were classified as Barcelona Clinic Liver Cancer B,and 61 patients(73.5%)were classified as Barcelona Clinic Liver Cancer C.Cirrhosis was present in 76 patients(91.6%),with 58 patients classified as Child-Turcotte-Pugh(CTP)A and 18 as CTP B.The median overall survival(OS)and progression-free survival were 13.0 mo[95%confidence interval(CI):5.2-20.8]and 9.0 mo(95%CI:5.0-13.0),respectively.The patients were divided into two groups based on mALBI grades:42 patients(50.6%)in the mALBI 1+2a group;and 41 patients(49.4%)in the mALBI 2b+3 group.During the median follow-up period of 7.0 mo,the mALBI 1+2a group exhibited significantly better survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 3.0 mo(95%CI:0.1-6.0,P<0.001).In a subgroup of patients with CTP A,the mALBI 1+2a group also showed significantly longer survival compared to the mALBI 2b+3 group,with a median OS that was not reached vs 6.0 mo(95%CI:3.4-8.6,P<0.001).In the multivariate analysis,both CTP class and mALBI grade were independently associated with survival,with adjusted hazard ratios(95%CI)of 2.63(1.19-5.78,P=0.020)and 3.90(1.71-8.90,P=0.001),respectively.CONCLUSION mALBI grades can determine survival of uHCC patients receiving AB treatment,particularly those who have mildly impaired liver function.This highlights the importance of assessing mALBI before initiating AB treatment to optimize therapeutic efficacy in clinical practice.

Child-Pugh、ALBI及aMAP分级在TACE联合仑伐替尼治疗中晚期肝细胞癌患者生存预后中的相关性分析

目的:比较Child-Pugh、ALBI及aMAP分级与TACE联合仑伐替尼治疗中晚期肝细胞癌患者生存预后的相关性。方法:回顾性收集2019年1月1日至2021年3月1日期间就诊于南方医科大学南方医院肝脏肿瘤中心的中晚期HCC患者的临床资料。采用Kaplan-Meier法计算生存时间并绘制生存曲线,Log-rank检验进行不同组别间的比较,cox比例风险回归模型以及95%CI的风险比(hazard ratio,HR)进行估计分析影响HCC患者OS的可能预后因素。单因素分析中P<0.1的变量进入到多因素cox回归分析。结果:最终94例完整病例纳入分析,其中男性84例(89.4%),女性10例(10.6%),平均年龄(53.3±11)岁。术后12个月,患者的ORR、DCR分别为60.6%(57/94)和87.2%(82/94)。截至2022年2月1日,共有45例(47.9%)患者死亡,49例(52.1%)存活,中位OS为18.6个月(95%CI,14.4-22.8);单因素COX回归分析结果显示,肿瘤最大直径≥7 cm、BCLC分期、AFP≥400 ng/mL、ALBI分级均与生存相关(均P<0.1);将上述指标纳入多因素COX回归分析显示:肿瘤最大直径≥7 cm,BCLC C期及ALBI分级(2/3级)均为患者OS的独立危险因素;进一步ROC曲线分析发现ALBI分级、BCLC分期和肿瘤最大直径≥7 cm的曲线下面积分别为0.910、0.705和0.809。结论:相较Child-Pugh及aMAP分级,ALBI可较好预测TACE联合仑伐替尼治疗中晚期HCC患者OS。

术前ALBI分级对肝细胞癌患者术后预后的预测价值的meta分析

目的评价术前白蛋白-胆红素(ALBI)分级与肝细胞癌(HCC)患者术后预后价值的关系。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、知网、万方、维普数据库,收集所有关于ALBI分级与HCC术后预后的相关性研究。检索时间为建库至2019年8月。采用RevMan 5.3和Stata 12.0软件进行数据分析,通过漏斗图评价发表偏倚。结果共纳入16篇文献,8820例患者。meta分析结果显示:术前高ALBI分级患者术后总生存期短于低ALBI分级患者(HR=1.47,95%CI:1.33~1.62,P<0.00001)。术前高ALBI分级患者无病生存期短于低ALBI分级患者(HR=1.67,95%CI:1.12~2.50,P=0.01)。结论术前ALBI分级是一种可用于预测肝癌术后预后的生物标志物。

Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma

BACKGROUND An ideal staging system for hepatocellular carcinoma(HCC)should rely on the hepatic reserve function and tumor burden.With the improvement in diagnostic and treatment strategies for HCC,in addition to recent treatment of viral hepatitis,finding a suitable assessment tool for hepatic reserve has become mandatory.AIM To validate a recently proposed modified albumin-bilirubin-TNM(mALBI-T)grade as a prognostic model for patients with HCC in Egypt.METHODS For patients diagnosed with HCC,Child-Turcotte-Pugh(CTP)score,Barcelona Clinic Liver Cancer(BCLC)stage,albumin-bilirubin(ALBI),plateltetalbumin– bilirubin(PALBI),ALBI-based BCLC,ALBI-T and mALBI-T grades were estimated.Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive.Overall survival and received treatments were determined.Survival data were analyzed.RESULTS A total of 1910 patients were included(mean age,57 years;1575 males).At presentation,50.6%had CTP A,36.1%had CTP B and 13.4%had CTP C;12%had ALBI grade 1,62.3%had ALBI grade 2 and 24.7%had ALBI grade 3.Overall median survival was 13 mo;survival was better in patients with ALBI 1 than in those with ALBI 2 and 3(28.6 vs 14 and 5.8 mo,respectively,P<0.001).Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2,3,4 and 5(P<0.001).The modified ALBI-T showed better stratification and significant improvement in prediction of survival.CONCLUSION ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage.mALBI-T is a better prognostic model in patients with HCC.

白蛋白-胆红素分级对经肝动脉化疗栓塞术治疗肝癌患者肝功能变化及其预后评估价值的Meta分析

目的分析白蛋白-胆红素(ALBI)分级对肝细胞癌(HCC)患者经肝动脉化疗栓塞术(TACE)后肝功能变化及其预后的评估价值。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、OVID、知网、万方、维普及中国生物医学文献数据库,收集所有关于ALBI分级对TACE治疗HCC患者肝功能变化及其预后评估的相关性研究,检索时间为数据库建立至2020年12月。对纳入文献进行质量评价及数据提取后,采用RevMan 5.3软件进行Meta分析。各研究间的异质性采用χ2检验判断;用HR或OR及其对应的95%CI评价结局指标;通过漏斗图评价发表偏倚。结果共纳入18篇文献,9940例患者。Meta分析结果显示:较高ALBI等级的HCC患者TACE后总生存期(OS)短于较低ALBI等级患者(2^(nd) vs 1^(st):HR=1.48,95%CI:1.39~1.57,P<0.00001;3^(rd) vs 1^(st):HR=2.45,95%CI:1.92~3.13,P<0.00001;3^(rd) vs 2^(nd):HR=1.91,95%CI:1.71~2.13,P<0.00001)。2次TACE累积导致的ALBI恶化程度高于1次TACE(OR=1.91,95%CI:1.27~2.88,P<0.05),3次TACE累积导致的ALBI恶化程度高于1次TACE(OR=3.21,95%CI:1.95~5.28,P<0.05),3次TACE累积导致的ALBI恶化程度高于2次TACE(OR=1.70,95%CI:1.07~2.70,P<0.05)。此外,ALBI可以预测TACE后慢加急性肝衰竭(ACLF)的发生(OR=4.57,95%CI:2.76~7.57,P<0.00001)。结论重复TACE治疗可导致肝功能持续恶化,并且ALBI分级对于评估TACE的预后及预测ACLF发生风险具有重要临床价值。

术前白蛋白-胆红素分级在胃癌根治术患者预后评估中的价值

目的探讨术前白蛋白-胆红素(ALBI)分级在胃癌(GC)根治术患者预后中的相关性。方法收集284例GC患者的临床病理资料。采用χ~2检验分析ABLI等级与临床病理资料的相关性,采用Log rank检验分析比较不同分组患者的生存率,分析影响患者预后独立风险因素采用多因素COX回归模型。结果 ALBI 1级和2级的GC患者人数分别为206、78;ALBI 2级的GC患者五年生存率(33.3%)低于1级(58.3%)。单因素分析显示肿瘤大小(P=0.015)、分化类型(P<0.01)、癌胚抗原(CEA)(P<0.01)、白蛋白(ALB)(P=0.033)、ALBI分级(P<0.01)、肿瘤分期(P<0.01)为影响GC患者预后的危险因素;多因素分析显示ALBI分级(P=0.027)、分化类型(P<0.01)、CEA(P<0.01)、肿瘤分期(P<0.01)可能为影响GC预后的独立危险因素。结论 ALBI分级可以作为一种简单的预测因子评估患者预后,并且可能为影响预后总生存率的独立危险因素。

基于Gd-EOB-DTPA增强MRI FLIS分析对预测肝功能的价值研究

目的通过分析钆塞酸二钠(Gd-EOB-DTPA)增强MRI肝胆期图像,探讨功能性肝脏影像评分(FLIS)对慢性肝病患者肝功能预测的临床价值。方法选择2019年6月至2020年2月在首都医科大学附属北京地坛医院行Gd-EOB-DTPA增强MRI检查患者110例,其中男性78例,女性32例;年龄25~73岁,平均年龄52岁。根据临床及实验室指标(包括血清总胆红素、血清白蛋白、国际标准化比值、腹水、肝性脑病分级),将患者行Child-Turcotte-Pugh(CTP)A、B、C分级及白蛋白-胆红素(ALBI)1、2、3分级。审阅Gd-EOB-DTPA增强MRI肝胆期图像,计算FLIS,采用χ2检验或Fisher确切概率法分析比较CTP级及ALBI级间FLIS发生率的差异。采用受试者工作特征曲线评价FLIS鉴别CTP级及ALBI不同级别肝功能的效能。结果FLIS 0~3分在CTP B级与CTP C级发生率依次增加,差异有统计学意义(CTP A级vs CTP B级:χ2=11.270,P=0.000;CTP A级vs CTP C级:χ2=45.162,P=0.000;CTP B级vs CTP C级:χ2=8.412,P=0.004)。ALBI 3级患者FLIS 0~3分发生率高于1级与2级患者,差异有显著统计学意义(ALBI 1级vs ALBI 3级:χ2=16.638,P=0.000;ALBI 2级vs ALBI 3级:χ2=7.334,P=0.007)。FLIS鉴别CTP A级与B级、CTP B级与C级、CTP A级与C级的曲线下面积分别为0.757、0.808、0.936;FLIS鉴别CTP A级与CTP B+C级曲线下面积0.801;FLIS鉴别ALBI 1级与2级、ALBI 2级与3级、ALBI 1与3级曲线下面积分别为0.626、0.717、0.811。结论FLIS能客观反映肝功能受损情况,对CTP及ALBI肝功能分级的鉴别诊断有一定价值。

Child-Pugh评分和白蛋白-胆红素分级在肝细胞癌经动脉化疗栓塞患者中预后的价值

目的探讨Child-Pugh评分和白蛋白一胆红素(ALBI)分级对肝细胞癌患者生存评估的预测价值。方法回顾性分析2013年6月至2018年6月郑州大学第二附属医院收治接受肝动脉化疗栓塞治疗的129例HCC患者临床资料。结果ALBI分级能够预测HCC患者的预后生存时间;ALBI分级对HCC患者预后生存时间的预测能力强于CP分级;ALBI-1级、ALBI-2级是影响HCC患者治疗后的独立危险因素。结论ALBI分级能有效预测HCC患者接受TACE治疗后的远期生存。

“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort

The“six-and-twelve”(6&12)score is a new hepatocellular carcinoma(HCC)prognostic index designed for recommended transarterial chemoembolization(TACE)candidates.Quick and easy to use by the sum of tumor size(cm)and number,this model identifies three groups with different survival time(the sum is≤6;or>6 but≤12;or>12);a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve.Recently,Wang ZW et al showed that the“6&12”model was the best system correlated with radiological response after the first TACE.Thus,we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems(Barcelona Clinic Liver Cancer,Hong Kong Liver Cancer(HKLC)staging,Albumin-Bilirubin grade,tumor nodularity,infiltrative nature of the tumor,alpha-fetoprotein,Child-Pugh class,and Performance Status score,Cancer of the Liver Italian Program,Model to Estimate Survival for HCC scores,up-to-seven criteria)different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled.As previously demonstrated,we show that the"6&12”score can classify survival within this French cohort,with a prognostic value comparable to that of other systems,except HKLC staging.More importantly,the“6&12”score simplicity and ability in patients’stratification outperform other systems for a routine clinical practice.

Child-Pugh评分和ALBI分级对BCLC-B期肝癌生存预后预测价值比较

目的比较Child-Pugh评分和ALBI分级对BCLC-B期肝细胞癌(肝癌)预后的预测价值。方法回顾性分析2010年1月至2014年12月空军军医大学第二附属医院收治的173例BCLC-B期肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男156例,女17例;平均年龄(59±12)岁。患者均采用微波消融辅助肝切除联合术后TACE治疗。对患者进行Child-Pugh评分及ALBI分级。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox回归模型分析预后危险因素。通过时间依赖的ROC曲线及C指数评价两种评分对预后的预测价值。结果Child-Pugh-5分患者的1、3、5年累积生存率为87.7%、59.3%、31.4%,6分患者相应为76.1%、36.4%、25.2%,两组总体生存率差异有统计学意义(χ^2=5.004,P<0.05)。ALBI分级1级患者1、3、5年累积生存率分别为92.2%、73.7%、53.7%,2级患者相应为74.5%、32.0%、15.0%,两组总体生存率差异有统计学意义(χ^2=20.415,P<0.05)。Cox多因素分析显示Child-Pugh评分及ALBI分级均是患者生存预后的独立影响因素(HR=1.559,2.947;P<0.05)。ALBI分级的C指数为0.64,Child-Pugh评分为0.58,ALBI分级的预测能力较Child-Pugh评分更高。结论对于行微波消融辅助肝切除联合术后TACE治疗的BCLC-B期肝癌患者,与Child-Pugh评分相比,ALBI分级对生存预后的预测能力更强。

Non-invasive strategies to predict post-hepatectomy liver failure

The ability to predict outcome in patients with cirrhosis remains a challenge for clinicians,particularly when intervention or operative management is required.The outcomes may be unpredictable and for individual patients,there is an imperative to be able to counsel them appropriately.A range of predictive scores have been generated and modified in order to facilitate these aims.

白蛋白-胆红素分级预测肝细胞癌根治性切除术后患者的预后

目的研究白蛋白-胆红素（ALBI）分级系统预测肝细胞癌（HCC）患者预后的价值。方法回顾性分析2010年5月至2013年5月湖南省常德市第一人民医院与广西医科大学附属肿瘤医院收治的符合入组标准的644例HCC患者临床资料。根据患者术前一周内外周血检测结果确定ALBI值。根据计算公式，将总人群分为ALBI 1级、ALBI 2级和ALBI 3级，用Kaplan-Meier法计算患者无瘤生存率和累积生存率。采用Cox比例风险模型确定危险因素。结果多因素分析结果表明，ALBI 2级是影响HCC患者总生存时间的独立危险因素（P〈0.05）。ALBI分级系统能将患者分为至少两个不同的总生存人群（P〈0.05）。此外ALBI分级系统还能将Child-Pugh （CP） A级患者分为两个不同的总生存人群（P〈0.05）。亚组分析结果表明，对于巴塞罗那临床肝癌分期（Barcelona Clinical Liver Cancer，BCLC）为0-C期的患者，ALBI分级系统仍然是一个较好的预测患者总生存的指标。结论对于R0切除术后HCC患者，ALBI分级系统是一个较好的预测总生存的指标，且在BCLC分期为0-C期的患者，以上结论也是成立的。