Changes in Background Liver Function in Patients with Hepatocellular Carcinoma over 30 Years: Comparison of Child-Pugh Classification and Albumin Bilirubin Grade
Changes in Background Liver Function in Patients with Hepatocellular Carcinoma over 30 Years: Comparison of Child-Pugh Classification and Albumin Bilirubin Grade
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DOI：
10.1159/000507933
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发表时间：
2020-09-01
期刊：
影响因子：
13.8
通讯作者：
Tanaka, Junko
中科院分区：
文献类型：
--
作者：
Kumada, Takashi;Toyoda, Hidenori;Tanaka, Junko
背景：随着各种治疗方法的进步，肝细胞癌（HCC）患者的肝功能得到了显著改善。最近，Child-Pugh分级（CPC）系统被认为在评估具有良好肝脏储备的患者方面能力有限。我们比较了白蛋白胆红素（ALBI）等级，这是适合于一个更详细的评估患者肝功能良好，与CPC超过30年的periods.Methods：共2,347例患者进行了分析。患者按诊断年份分为6组：A组（1990-1994，n= 376），B组（1995-1999年，n= 434）、C组（2000-2004年，n= 438）、D组（2005-2009年，n= 444）、E组（2010-2014年，n= 392）和F组（2015-2018年，n= 263）。结果：在整个研究期间，诊断为CPC A的患者的患病率增加，在E组和F组中达到近80%（p< 0.001）。相比之下，在E组和F组中，ALBI 1级疾病患者的百分比保持在约50%（p< 0.001）。改良ALBI（mALBI）2a级对应于肝功能较差的CPC A患者。在CPC A患者中，mALBI 1级与2a级、1级与2b级以及2a级与2b级疾病患者之间的生存率分别存在显著差异（p< 0.0001）。结论：CPC不适用于评估近期诊断为HCC且残余肝功能良好的患者。在此类HCC患者中，预后可以通过ALBI分级而不是CPC分层。
Background:Background liver function in patients with hepatocellular carcinoma (HCC) has improved remarkably with advances in various treatments. Recently, the Child-Pugh classification (CPC) system has been recognized as limited in its ability to assess patients with good hepatic reserve. We compared the albumin-bilirubin (ALBI) grade, which is suitable for a more detailed evaluation of patients with good liver function, with CPC over a 30-year period.Methods:A total of 2,347 patients were analyzed. Patients were stratified by year of diagnosis into 6 groups: Group A (1990-1994,n= 376), Group B (1995-1999,n= 434), Group C (2000-2004,n= 438), Group D (2005-2009,n= 444), Group E (2010-2014,n= 392), and Group F (2015-2018,n= 263). We compared ALBI grade and CPC across the groups.Results:The prevalence of patients with CPC A at diagnosis increased throughout the study period, reaching nearly 80% in Groups E and F (p< 0.001). By contrast, the percentage of patients with ALBI grade 1 disease remained approximately 50% in Groups E and F (p< 0.001). Modified ALBI (mALBI) grade 2a corresponds to patients with CPC A who have poor hepatic function. There were significant survival differences between patients with mALBI grade 1 versus 2a, 1 versus 2b, and 2a versus 2b disease, respectively (p< 0.0001), in patients with CPC A.Conclusions:CPC is not suitable for assessing patients with recently diagnosed HCC and good remnant hepatic function. In such patients with HCC, the prognosis can be stratified by ALBI grade rather than CPC.