Assessment of the Albumin-Bilirubin (ALBI) Grade as a Prognostic Indicator for Hepatocellular Carcinoma Patients Treated With Radioembolization.
Assessment of the Albumin-Bilirubin (ALBI) Grade as a Prognostic Indicator for Hepatocellular Carcinoma Patients Treated With Radioembolization.
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DOI：
10.1097/coc.0000000000000384
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发表时间：
2018-09
期刊：
影响因子：
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通讯作者：
Jabbour SK
中科院分区：
文献类型：
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作者：
Gui B;Weiner AA;Nosher J;Lu SE;Foltz GM;Hasan O;Kim SK;Gendel V;Mani NB;Carpizo DR;Saad NE;Kennedy TJ;Zuckerman DA;Olsen JR;Parikh PJ;Jabbour SK
由于Child-Pugh（C-P）分级的实用性受到腹水和脑病的主观性的限制，我们评价了先前建立的客观方法，白蛋白胆红素（ALBI）分级，作为肝细胞癌（HCC）患者钇-90放射栓塞（RE）治疗的指标。共对来自2个学术中心的117例接受RE治疗的HCC患者进行了审查，并按ALBI分级、C-P分级和巴塞罗那临床肝癌分期进行分层。采用Kaplan-Meier生存分析评价3种标准的总生存期（OS）。采用log-rank检验比较C-P分级和ALBI分级作为预后指标的实用性。进行多变量考克斯回归分析以确定其他预测因素。ALBI 1级患者（n = 49）的OS优于ALBI 2级患者（n = 65）（P = 0.01）。C-P A级患者100例，C-P B级患者14例，两组患者的总生存期比较差异无统计学意义（P = 0.11）。对于C-P A级患者，ALBI分级（1 vs. 2）能够分层2个具有不同OS曲线的明确和非重叠亚组（P = 0.03）。多因素考克斯回归分析显示丙氨酸转氨酶、巴塞罗那临床肝癌分期和ALBI分级是OS的最强预后因素（P < 0.10）。ALBI分级作为一个衡量指标，在接受RE治疗的HCC患者中，特别是在C-P A级患者亚组中，显示出明显上级C-P级的生存区分。ALBI分级有助于临床医生决定是否应向HCC患者推荐RE。
As the utility of Child-Pugh (C-P) class is limited by the subjectivity of ascites and encephalopathy, we evaluated a previously established objective method, the albumin-bilirubin (ALBI) grade, as a prognosticator for yttrium-90 radioembolization (RE) treatment for patients with hepatocellular carcinoma (HCC). A total of 117 patients who received RE for HCC from 2 academic centers were reviewed and stratified by ALBI grade, C-P class, and Barcelona Clinic Liver Cancer stage. The overall survival (OS) according to these 3 criteria was evaluated by Kaplan-Meier survival analysis. The utilities of C-P class and ALBI grade as prognostic indicators were compared using the log-rank test. Multivariate Cox regression analysis was performed to identify additional predictive factors. Patients with ALBI grade 1 (n = 49) had superior OS than those with ALBI grade 2 (n = 65) (P = 0.01). Meanwhile, no significant difference was observed in OS between C-P class A (n = 100) and C-P class B (n = 14) (P = 0.11). For C-P class A patients, the ALBI grade (1 vs. 2) was able to stratify 2 clear and nonoverlapping subgroups with differing OS curves (P = 0.03). Multivariate Cox regression test identified alanine transaminase, Barcelona Clinic Liver Cancer stage, and ALBI grade as the strongest prognostic factors for OS (P < 0.10). ALBI grade as a prognosticator has demonstrated clear survival discrimination that is superior to C-P class among HCC patients treated with RE, particularly within the subgroup of C-P class A patients. ALBI grade is useful for clinicians to make decisions as to whether RE should be recommended to patients with HCC.