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Child-Pugh评分和ALBI分级预测经肝动脉化疗栓塞治疗不可切除肝细胞癌预后的价值比较
Value of Child-Pugh score versus albumin-bilirubin grade in predicting the prognosis of unresectable hepatocellular carcinoma treated by transarterial chemoembolization
文章发布日期:2019年12月20日  来源:  作者:王哲轩,王恩鑫,夏冬东,等  点击次数:492次  下载次数:114次

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【摘要】:目的 在经肝动脉化疗栓塞术(TACE)治疗的肝功能良好的肝细胞癌患者中,评估并比较Child-Pugh评分和ALBI分级对患者总生存情况的预测能力。方法 回顾性收集2010年1月-2014年12月在空军军医大学西京消化病医院接受TACE治疗的不可切除185例HCC患者,收集患者的流行病学资料(年龄、性别、病因等),实验室检查资料(血常规、肝肾功能、凝血功能等),以及影像学检查资料(肿瘤大小、数目等),计算总生存时间,根据其基线状态以及实验室检查结果计算Child-Pugh评分和ALBI分级。使用Child-Pugh评分和ALBI评分进行危险分层,采用Kaplan-Meier绘制生存曲线,log-rank检验对总生存时间进行分析比较。Cox回归模型进行危险因素分析。通过依时ROC曲线分析和C指数比较2种评分预测生存情况的能力。结果 根据Child-Pugh评分,5分患者的中位生存时间及95%可信区间(95%CI)为25.3(20.1~30.5)个月;6分患者的中位生存时间为8.6(7.5~16.9)个月,2者生存时间比较差异有统计学意义(P=0.002);根据ALBI评分,1级的患者中位生存时间为29.1(25.9~32.3)个月,2级患者的中位生存时间为15.1(12.7~17.6)个月,2者生存时间比较差异有统计学意义(P<0.001)。单因素分析结果显示,ECOG评分、肿瘤大小、肿瘤数目、AFP、AST、Alb、TBil、Child-Pugh评分以及ALBI分级均与生存相关(P值均<0.05);多因素分析调整风险比(HR)之后,白蛋白[HR(95%CI): 0.93(0.90~0.97),P<0.001)]、胆红素[HR(95%CI): 1.04(1.02~1.06), P<0.001)]、Child-Pugh评分[HR(95%CI): 1.75(1.18~2.59), P=0.005)]以及ALBI评分[HR(95%CI): 1.82(1.29~2.59), P=0.001]均是患者总生存时间的独立预测因素。根据依时ROC曲线,随着观察时间的延长,Child-Pugh评分对生存的预测能力呈下降趋势,而ALBI评分的预测能力比较稳定。在预测1年以内的生存方面,2种评分方式预测能力相近,而随着时间的延长,ALBI评分的预测价值更高。Child-Pugh评分的C指数略低于ALBI的C指数为[0.57(95%CI: 0.53~0.60) vs 0.63(95%CI: 0.57~0.68)]。结论 对于接受单纯TACE治疗的肝细胞癌患者,ALBI评分与Child-Pugh评分均是生存时间的独立预测因素,但是ALBI的远期预测能力相对更好。
【Abstract】:Objective To investigate the ability of Child-Pugh score versus albumin-bilirubin (ALBI) grade in predicting the overall survival of hepatocellular carcinoma (HCC) patients with good liver function undergoing transarterial chemoembolization (TACE). Methods A retrospective analysis was performed for the clinical data of 185 patients with unresectable HCC who underwent TACE in Xijing Hospital of Digestive Diseases, Air Force Medical University, from January 2010 to December 2014, including epidemiological data (age, sex, and etiology), laboratory parameters (routine blood test results, hepatic and renal function, and coagulation function), and imaging data (tumor size and number). Overall survival time was calculated, and Child-Pugh score and ALBI grade were determined based on baseline data and laboratory results. Risk stratification was performed based on Child-Pugh score and ALBI grade, the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare overall survival. The Cox regression model was used to analyze risk factors. The time-dependent receiver operating characteristic (ROC) curve and C-index were used to compare the ability of Child-Pugh score and ALBI grade in predicting survival. Results According to Child-Pugh score, the patients with 5 points had a median survival time of 253 months (95% confidence interval [CI]: 20.1-30.5 months), and those with 6 points had a median survival time of 8.6 months (95%CI: 7.5-16.9 months); there was a significant difference between them (P=0.002). According to ALBI grade, the patients with ALBI grade 1 had a median survival time of 29.1 months (95%CI: 25.9-32.3 months), and those with ALBI grade 2 had a median survival time of 15.1 months (95%CI: 12.7-17.6 months); there was a significant difference in survival tine between them (P<0.001). ECOG score, tumor size, number of tumors, alpha-fetoprotein, aspartate aminotransferase, albumin, total bilirubin, Child-Pugh score, and ALBI grade were associated with survival (all P<0.05). The three analytical models showed that after the adjustment for hazard ratio (HR) in the multivariate analysis, albumin (HR=0.93, 95%CI: 0.90-0.97, P<0.001), bilirubin (HR=1.04, 95%CI: 1.02-1.06, P<0.001), Child-Pugh score (HR=1.75, 95%CI: 1.18-2.59, P=0.005), and ALBI grade (HR=1.82, 95%CI: 1.29-2.59, P=0.001) independently predicted the overall survival of the patients. The time-dependent ROC curve analysis showed that the ability of Child-Pugh score in predicting survival tended to decrease over the time of observation, while the ability of ALBI grade remained relatively stable. These two systems had a similar ability in predicting survival within 12 months, while ALBI grade had a better ability than Child-Pugh score thereafter. Child-Pugh score had a slightly lower C-index than ALBI grade [0.57 (95%CI: 0.53-0.60) vs 0.63 (95%CI: 0.57-0.68)]. Conclusion Both ALBI grade and Child-Pugh score can be used for prognostic stratification of HCC patients undergoing TACE alone, but ALBI grade has a better long-term predictive ability than Child-Pugh score.
【关键字】:癌,肝细胞; 化学栓塞,治疗性; 预后; 预测
【Key words】:carcinoma,hepatocellular; chemoembolization,therapeutic; prognosis; forecasting
【引证本文】:WANG ZX, WANG EX, XIA DD, et al. Value of Child-Pugh score versus albumin-bilirubin grade in predicting the prognosis of unresectable hepatocellular carcinoma treated by transarterial chemoembolization[J]. J Clin Hepatol, 2020, 36(1): 113-117. (in Chinese)
王哲轩, 王恩鑫, 夏冬东, 等. Child-Pugh评分和ALBI分级预测经肝动脉化疗栓塞治疗不可切除肝细胞癌预后的价值比较[J]. 临床肝胆病杂志, 2020, 36(1): 113-117.

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