Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach-The ALBI Grade
Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach-The ALBI Grade
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DOI：
10.1200/jco.2014.57.9151
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发表时间：
2015-02-20
影响因子：
45.3
通讯作者：
Toyoda, Hidenori
中科院分区：
文献类型：
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作者：
Johnson, Philip J.;Berhane, Sarah;Toyoda, Hidenori
大多数肝细胞癌（HCC）患者伴有慢性肝病，目前对其严重程度的评估是Child-Pugh（C-P）分级。在这一国际合作中，我们确定了客观的措施，肝功能/功能障碍，独立影响生存的HCC患者，然后联合收割机这些到一个模型，可以与传统的C-P grade.Patients和MethodsWe开发了一个简单的模型来评估肝功能，基于1,313例HCC的所有阶段，从日本，只涉及血清胆红素和白蛋白水平。然后，我们使用来自其他地理区域（n = 5，097）和其他临床情况（接受切除术[n = 525]或索拉非尼治疗晚期HCC [n = 1，132]的患者）的类似队列测试模型。该模型的特异性肝（dys）功能进行了测试，在慢性肝病患者，但没有HCC（n = 501）。ResultsThe模型，白蛋白-胆红素（ALBI）级，至少以及在所有地理区域的C-P级。大多数HCC患者在就诊时为C-P A级疾病，在此C-P分级中，ALBI显示两类具有明显不同的病变。它的效用在慢性肝病患者单独支持的论点，ALBI等级确实是一个指标的肝（dys）function.ConclusionThe ALBI等级提供了一个简单的，以证据为基础的，客观的，和歧视性的方法评估肝细胞癌的肝功能，已被广泛测试在国际环境。这种新的模型消除了对主观变量的需要，如腹水和脑病，这是传统C-P分级的要求。(C)2014年美国临床肿瘤学会
PurposeMost patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade.Patients and MethodsWe developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501).ResultsThe model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function.ConclusionThe ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade. (C) 2014 by American Society of Clinical Oncology