经导管动脉内治疗加靶向治疗和PD-(L)1抑制剂治疗肝癌患者Child-Pugh分级和ALBI分级变化的预后价值

IF 4.2 3区医学 Q2 ONCOLOGY

Journal of Hepatocellular Carcinoma Pub Date : 2025-03-04 eCollection Date: 2025-01-01 DOI:10.2147/JHC.S490439

Xiaoyu Huang, Xiaojing Cao, Yaqing Kong, Fan Tang, Tianhao Cong, Xiang Zhou

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The discrimination of the scoring systems was determined by concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC).Results: Among CP-A patients (n = 137), 11.68% (n = 16) progressed to CP-B by 20-28 weeks (p < 0.001). Multivariate analysis identified CP/ALBI grade at 20-28 weeks as an independent prognostic factor for OS (grade 2 vs grade 1, hazard ratio [HR] 3.12, p < 0.001; grade 3 vs grade 1, HR 4.95, p < 0.001) and at 4-8 weeks for PFS (grade 3 vs grade 1, HR 3.26, p = 0.002). The combination of CP/ALBI grade and baseline clinical prognostic factors (Eastern Cooperative Oncology Group Performance Status, Barcelona Clinic Liver Cancer stage, tumor size) demonstrated superior discrimination for OS (C-index: 0.74-0.77; time-dependent AUC: 0.74-0.92). 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引用次数: 0

摘要

目的：本研究旨在探讨肝细胞癌（HCC）患者经导管动脉内治疗联合分子靶向药物和程序性细胞死亡-1（配体-1）抑制剂治疗后肝功能的变化，并评价Child-Pugh （CP）分级和白蛋白-胆红素（ALBI）分级（CP/ALBI）联合治疗的预后意义。方法：回顾性研究。2019 - 2023年中国共纳入149例患者。评估治疗后4-8周、12-16周和20-28周CP评分、ALBI分级和CP/ALBI分级的变化。Cox回归模型确定了总生存期（OS）和无进展生存期（PFS）的预后因素。采用一致性指数（C-index）和受试者工作特征曲线下的时间依赖面积（AUC）来确定评分系统的判别性。结果：CP-A患者（n = 137）中，11.68% （n = 16）在20-28周进展为CP-B （p < 0.001）。多因素分析发现，20-28周时CP/ALBI分级是OS的独立预后因素(2级vs 1级，风险比[HR] 3.12, p < 0.001；3级vs 1级，HR 4.95, p < 0.001)和4-8周PFS（3级vs 1级，HR 3.26, p = 0.002）。结合CP/ALBI分级和基线临床预后因素（东部肿瘤合作组表现状况、巴塞罗那临床肝癌分期、肿瘤大小）对OS的鉴别效果较好(c指数：0.74-0.77；随时间变化的AUC: 0.74-0.92)。与CP- a患者维持CP/ALBI 1级相关的基线因素包括ALBI 1级（比值比[OR] 3.09, p = 0.030）和天冬氨酸转氨酶< 40 U/L（比值比[OR] 3.35, p = 0.017）。结论：HCC患者在联合治疗28周内出现肝功能恶化的比例虽小但显著。动态监测CP/ALBI分级为患者分层提供了有价值的预后见解。

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Prognostic Value of Changes in Combined Child-Pugh Class and ALBI Grade in Hepatocellular Carcinoma Treated with Transcatheter Intra-Arterial Therapy Plus Targeted Therapy and PD-(L)1 Inhibitors.

Purpose: This study aims to investigate liver function changes in hepatocellular carcinoma (HCC) patients treated with transcatheter intra-arterial therapy plus molecular targeted agents and programmed cell death-1 (ligand-1) inhibitors, and evaluate the prognostic significance of the combination of Child-Pugh (CP) class and albumin-bilirubin (ALBI) grade (CP/ALBI).

Methods: This is a retrospective study. A total of 149 patients from 2019 to 2023 in China were included. Changes in CP score, ALBI grade, and CP/ALBI grade at 4-8 weeks, 12-16 weeks, and 20-28 weeks post-treatment was evaluated. Cox regression models identified prognostic factors for overall survival (OS) and progression-free survival (PFS). The discrimination of the scoring systems was determined by concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC).

Results: Among CP-A patients (n = 137), 11.68% (n = 16) progressed to CP-B by 20-28 weeks (p < 0.001). Multivariate analysis identified CP/ALBI grade at 20-28 weeks as an independent prognostic factor for OS (grade 2 vs grade 1, hazard ratio [HR] 3.12, p < 0.001; grade 3 vs grade 1, HR 4.95, p < 0.001) and at 4-8 weeks for PFS (grade 3 vs grade 1, HR 3.26, p = 0.002). The combination of CP/ALBI grade and baseline clinical prognostic factors (Eastern Cooperative Oncology Group Performance Status, Barcelona Clinic Liver Cancer stage, tumor size) demonstrated superior discrimination for OS (C-index: 0.74-0.77; time-dependent AUC: 0.74-0.92). Baseline factors associated with maintaining CP/ALBI grade 1 in CP-A patients included ALBI grade 1 (odds ratio [OR] 3.09, p = 0.030) and aspartate aminotransferase < 40 U/L (OR 3.35, p = 0.017).

Conclusion: A small but notable proportion of HCC patients experienced liver function deterioration within 28-week of combined treatment. Dynamic monitoring of CP/ALBI grade provides valuable prognostic insights for patient stratification.

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