【摘要】 目的 本研究旨在探讨白蛋白-胆红素(albumin-bilirubin, ALBI)分级在接受根治性手术切除的肝细胞癌患者中的预后意义。方法 回归性分析2015年01月至2018年12月间于我院收治并行手术治疗的126例肝细胞癌患者的临床病理资料、术前1周内的血清白蛋白与胆红素水平。根据白蛋白-胆红素分级，将病人分为ALBI 1级(n=69)和ALBI 2～3级(n=57)。比较各项临床病理参数在两组患者中的差异，以明确白蛋白-胆红素分级与肝细胞癌患者的临床病理特征的关系。通过Kaplan-Meier生存曲线计算ALBI 1级与ALBI 2～3级患者的总体生存，组间差异比较采用log-rank检验。此外，通过Cox风险比例回归模型(LR向前法)确定白蛋白-胆红素分级在肝细胞癌患者中的独立预后价值。结果 术前高白蛋白-胆红素分级(ALBI 2～3级)与肿瘤大小(χ~2=7.092,P=0.008)、TNM分期(χ~2=11.838,P<0.001)、肝癌BCLC临床分期(χ~2=6.925,P=0.031)、血管侵犯(χ~2=5.155,P=0.023)及PNI (χ~2=14.814,P<0.001)显著相关。生存曲线表明高白蛋白-胆红素分级是肝细胞癌患者预后不佳的标志，ALBI 1级与ALBI 2～3级患者的3年总体OS分别为46.1%与15.1%,差异具有统计学意义(χ~2=20.738,P<0.001)。亚组分析进一步展示白蛋白-胆红素分级可以较好地区分不同TNM分期(I～II期，3年OS:85.5%vs 33.3%,χ~2=6.080,P=0.014; III期，20.8%vs 12.3%,χ~2=5.929,P=0.015)或BCLC分期(A-B期，3年OS:55.0%vs 4.3%,χ~2=15.745,P<0.001; C期，23.5%vs 0%,χ~2=5.511,P=0.019)患者的预后结局。另外，多因素COX分析的结果揭示肿瘤直径≥5 cm (风险比HR:2.500, 95%置信区间：1.109～5.635,P=0.027)、TNM III期(风险比HR:3.989, 95%置信区间：1.865～8.534,P<0.001)、术前血清AFP≥400 ng/mL(风险比HR:1.779, 95%置信区间：1.117～2.835,P=0.015)及ALBI 2～3级(风险比HR:2.129, 95%置信区间：1.305～3.471,P=0.002)是肝细胞癌患者的独立预后因素。结论 白蛋白-胆红素分级有助于区分接受根治性肝切除治疗的肝细胞癌患者的生存结局，是一项有价值的预后评价指标。更多还原

【Abstract】 Objective The purpose of this study was to investigate the prognostic significance of albumin-bilirubin(ALBI) grade for patients who underwent curative resection for hepatocellular carcinoma. Methods A total of 126 patients who underwent surgical resection for hepatocellular carcinoma in our institution between June 2015 and February 2019 were included in the present study, and the clinicopathological data, preoperative serum albumin and bilirubin levels within one week of these patients were retrospectively analyzed. All patients were divided into ALBI grade I(n=69) and grade II～III(n=57) group according to the albumin-bilirubin grade. The clinicopathological parameters of the two groups were compared in order to clarify the relationship between albumin-bilirubin grade and clinicopathological characteristics of hepatocellular carcinoma. Kaplan-Meier curves were plotted to evaluate the overall survival(OS) of hepatocellular carcinoma patients with ALBI grade I and grade II～III, and log-rank test was used to compare the survival difference between the two groups. What’s more, the multivariate Cox proportional hazards regression model was used to determine the independent prognostic significance of albumin-bilirubin grade for hepatocellular carcinoma patients. Results Preoperative albumin-bilirubin grade(ALBI grade II～III) was markedly associated with tumor size(χ~2=7.092, P=0.008), TNM stage(χ~2=11.838, P<0.001), BCLC clinical stage(χ~2=6.925, P=0.031), vascular invasion(χ~2=5.155, P=0.023) and prognostic nutritional index(PNI)(χ~2=14.814, P<0.001). Kaplan-Meier curves showed that the 3-year OS of patients with ALBI grade I and grade II～III was 46.1% and 15.1%, respectively, with a significantly statistical difference(χ~2=20.738, P<0.001). ALBI grade II～III was an indicator of poor survival in hepatocellular carcinoma patients. Subgroup analysis further demonstrated that the long-term survival outcome of hepatocellular carcinoma patients with different TNM stage(I～II stage, 3-year OS for ALBI grade I and grade II～III: 85.5% vs 33.3%, χ~2=6.080, P=0.014; III stage, 20.8% vs 12.3%, χ~2=5.929, P=0.015) or BCLC clinical stage(A-B stage, 3-year OS: 55.0% vs 4.3%, χ~2=15.745, P<0.001; C stage, 23.5% vs 0%, χ~2=5.511, P=0.019) could be better distinguished by albumin-bilirubin grade. Moreover, the multivariate Cox analysis revealed that tumor diameter ≥ 5 cm(HR: 2.500, 95% confidence interval[CI]: 1.109～5.635, P=0.027), TNM stage III(HR: 3.989, 95%CI: 1.865～8.534, P<0.001), preoperative serum AFP level ≥ 400 ng/ml(HR: 1.779, 95% CI: 1.117～2.835, P=0.015) and ALBI grade II～III(HR: 2.129, 95% CI: 1.305～3.471, P=0.002) were independent prognostic factors for hepatocellular carcinoma patients. Conclusion Albumin-bilirubin grade is helpful to stratify the prognostic outcome of hepatocellular carcinoma patients who underwent radical hepatectomy, and it is considered as a valuable prognostic indicator.更多还原