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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (01) : 38 -42. doi: 10.3877/cma.j.issn.2095-3232.2021.01.009

所属专题： 文献；

临床研究

Child-Pugh评分和ALBI分级对BCLC-B期肝癌生存预后预测价值比较
赵首捷1, 杨振宇1, 雷世雄1, 谭凯1, 刘雷2,†()   
  1. 1. 710032　西安，空军军医大学第二附属医院普通外科
    2. 710032　西安，空军军医大学第二附属医院消化内科
  • 收稿日期:2020-09-19 出版日期:2021-02-10
  • 通信作者: 刘雷
  • 基金资助:
    国家自然科学基金(81702999); 陕西省创新能力支撑计划项目(2018KJXX-076)

Comparison of prognostic value between Child-Pugh score and albumin-bilirubin grading for patients with BCLC-B stage hepatocellular carcinoma

Shoujie Zhao1, Zhenyu Yang1, Shixiong Lei1, Kai Tan1, Lei Liu2,†()   

  1. 1. Department of General Surgery, Second Affiliated Hospital of Air Military Medical University, Xi'an 710032, China
    2. Department of Gastroenterology, Second Affiliated Hospital of Air Military Medical University, Xi'an 710032, China
  • Received:2020-09-19 Published:2021-02-10
  • Corresponding author: Lei Liu
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赵首捷, 杨振宇, 雷世雄, 谭凯, 刘雷. Child-Pugh评分和ALBI分级对BCLC-B期肝癌生存预后预测价值比较[J]. 中华肝脏外科手术学电子杂志, 2021, 10(01): 38-42.

Shoujie Zhao, Zhenyu Yang, Shixiong Lei, Kai Tan, Lei Liu. Comparison of prognostic value between Child-Pugh score and albumin-bilirubin grading for patients with BCLC-B stage hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(01): 38-42.

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（χ2=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（χ2=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。

关键词: 癌, 肝细胞, Child-Pugh评分, ALBI分级, 预后
Objective

To compare the prognostic value between Child-Pugh score and albumin-bilirubin (ALBI) grading for patients with BCLC-B stage hepatocellular carcinoma (HCC).

Methods

Clinical data of 173 patients with BCLC-B stage HCC admitted to the Second Affiliated Hospital of Air Military Medical University from January 2010 to December 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 156 patients were male and 17 females, aged (59±12) years on average. All patients were treated with microwave ablation-assisted hepatectomy and postoperative TACE. Child-Pugh score and ALBI grade of the patients were calculated. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The prognostic risk factors were identified by Cox regression model. The prognostic value of two score system were evaluated by using time-dependent receiver operating characteristic (ROC) curve and C-index.

Results

The 1-, 3- and 5-year cumulative survival rates of patients with a Child-Pugh score of 5 were 87.7%, 59.3% and 31.4%, respectively, and were 76.1%, 36.4% and 25.2% in patients with Child-Pugh score of 6, where significant difference was observed (χ2=5.004, P<0.05). The 1-, 3- and 5-year cumulative survival rates of patients with ALBI grade 1 were 92.2%, 73.7%, and 53.7%, and were 74.5%, 32.0%, and 15.0% in those with ALBI grade 2, where significant difference was observed (χ2=20.415, P<0.05). Cox multivariate analysis showed that Child-Pugh score and ALBI grade were the independent risk factors for the survival and prognosis of HCC patients (HR=1.559, 2.947; P<0.05). The C-index of ALBI grade was 0.64, while it was 0.58 for Child-Pugh score. The predictive ability of ALBI grade was higher than that of Child-Pugh score.

Conclusions

Compared with Child-Pugh score, ALBI grade yields a better predictive ability for the survival and prognosis of BCLC-B stage HCC patients undergoing microwave ablation-assisted hepatectomy and postoperative TACE.

Key words: Carcinoma, hepatocellular, Child-Pugh score, ALBI grade, Prognosis
图1 Child-Pugh-5和Child-Pugh-6组BCLC-B期肝癌患者Kaplan-Meier生存曲线
图2 ALBI-1和ALBI-2组BCLC-B期肝癌患者Kaplan-Meier生存曲线
表1 BCLC-B期肝癌患者术后预后Cox多因素分析
指标 模型1 模型2 模型3
HR（95%CI） P值 HR（95%CI） P值 HR（95%CI） P值
HBsAg阳性 1.007（1.001～1.013） 0.023 1.014（1.009～1.022） <0.001 1.012（1.006～1.019） <0.001
ALB(g/L) 0.942（0.853～0.986） <0.001 - - - -
TB(μmol/L) 1.071（1.039～1.104） <0.001 - - - -
肿瘤直径(cm) 1.074（1.017～1.139） 0.010 1.071（1.015～1.137） 0.013 1.067（1.011～1.126） 0.022
Child-Pugh-6分 - - 1.559（1.043～2.568） 0.037 - -
ALBI-2级 - - - - 2.947（1.720～5.051） <0.001
图3 ALBI分级和Child-Pugh评分预测肝癌患者术后生存的ROC曲线
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