| 基于ALBI评分、TBS评分及LDH水平构建的COX回归模型对HCC患者肝切除术后的预后价值 |
| 投稿时间：2024-10-15 修订日期：2024-11-14 点此下载全文 |
| 引用本文：张旋,王根年,李永芳,魏丰贤,王哲元,张有成.基于ALBI评分、TBS评分及LDH水平构建的COX回归模型对HCC患者肝切除术后的预后价值[J].医学研究杂志,2025,54(4):89-95 |
| DOI：
10.11969/j.issn.1673-548X.2025.04.017 |
| 摘要点击次数: 46 |
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| 基金项目:甘肃省自然科学基金资助项目(23JRRA0992);甘肃省青年科技基金资助项目(21JR1RA161) |
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| 中文摘要:目的 探究白蛋白-胆红素评分(albumin-bilirubin score,ALBI)、肿瘤负荷评分(tumor burden score,TBS)及乳酸脱氢酶(lactic dehydrogenase,LDH)水平联合对预测肝细胞癌(hepatocellular carcinoma,HCC)患者行根治性肝切除术后预后的预测价值。方法 回顾性收集2011年1月～2022年1月兰州大学第二医院普外科行原发性肝癌根治性肝切除术患者的临床资料,包括患者的个人基本信息、相关实验室检查、影像学资料、病理报告和随访资料如总生存期(overall survival,OS)等,OS定义为从研究开始至因肝癌原因引起死亡的时间。本研究涉及162例患者。以最后一次随访时患者生存状态分为生存组和死亡组,受试者工作特征曲线下面积(area under curve,AUC)用于估计不同模型的预测准确性。结果 研究期间,共79例患者(48.7%)发生死亡。中位生存时间为46.5个月。通过单因素及多因素分析后确定甲胎蛋白及乳酸脱氢酶为术后总生存期的2个独立危险因素(P<0.05)。基于ALBI评分、TBS评分及LDH水平构建的COX回归模型ALBI-TBS-LDH综合评分预测根治性肝切除术后死亡发生的AUC高于ALBI评分、TBS评分。根据最佳Youden指数,取ALBI-TBS-LDH综合评分的最佳诊断界值为-0.18时,其预测死亡发生的敏感度和特异性分别为63.4%和71.8%,ALBI-TBS-LDH评分＜-0.18的患者1年、3年和5年的总生存率分别为95.1%、80.5%和39.0%；评分≥-0.18的患者1年、3年和5年的总生存率分别为86.6%、59.7%和22.4%,差异有统计学意义(P<0.001)。结论 ALBI-TBS-LDH评分可作为评估肝切除术后HCC患者预后的简单工具,但其作用仍需要进一步研究验证。ALBI-TBS-LDH评分高的患者术后死亡的发生率更高,生存时间较评分低的患者更短。 |
| 中文关键词:白蛋白-胆红素评分 肿瘤负荷评分 乳酸脱氢酶 根治性肝切除术 肝细胞癌 |
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| Prognostic Value of COX Regression Model Based on ALBI Score, TBS Score and LDH Level in Patients with Hepatocellular Carcinoma after Radical Liver Resection. |
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| Abstract:Objective To investigate the predictive value of albumin-bilirubin score (ALBI), tumor burden score (TBS) and lactate dehydrogenase (LDH) level in predicting the prognosis of HCC patients after radical hepatectomy. Methods The clinical data of patients who underwent radical hepatectomy for primary liver cancer in the Department of General Surgery, The Second Hospital of Lanzhou University from January 2011 to January 2022 were retrospectively collected, including the patients′ basic personal information, relevant laboratory tests, imaging data, pathological reports and follow-up data. This study involved 162 patients. The patients were divided into survival group and death group according to their survival status at the last follow-up, and the area under the receiver operating characteristic curve (AUC) was used to estimate the prediction accuracy of different models. Results During the study period, a total of 79 patients (48.7%) died. The median survival time was 46.5months. AFP and LDH were identified as two independent risk factors for overall survival after surgery by univariate and multivariate analysis (P<0.05). The AUC of ALBI-TBS-LDH score for predicting death after radical hepatectomy was higher than that of ALBI score and TBS score. According to the optimal Youden index, when the optimal diagnostic cutoff value of ALBI-TBS-LDH score was -0.18, the sensitivity and specificity of predicting death were 63.4% and 71.8%, respectively. The 1-year, 3-year and 5-year overall survival rates of patients with ALBI-TBS-LDH score < -0.18 were 95.1%, 80.5% and 39.0%, respectively; the 1-year, 3-year and 5-year overall survival rates of patients with score≥-0.18 were 86.6%, 59.7% and 22.4%, respectively, with statistically significant differences (P<0.001). Conclusion The ALBI-TBS-LDH score can be used as a simple tool to evaluate the prognosis of HCC patients after liver resection, but its role still needs further research and verification. Patients with high ALBI-TBS-LDH scores have a higher incidence of postoperative death and a shorter survival time than those with low scores. |
| keywords:Albumin-bilirubin score Tumor burden score Lactic dehydrogenase Radical hepatectomy Hepatocellular carcinoma |
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