PALBI评分对肝癌肝移植受者术后肿瘤复发的预测价值  

Predictive value of platelet-albumin-bilirubin score for tumor recurrence after liver transplantation for hepatocellular carcinoma

作　　者：杨程凯 许嘉绵 王华翔 李嘉伟 吕立志 江艺 Yang Chengkai;Xu Jiamian;Wang Huaxiang;Li Jiawei;Lyu Lizhi;Jiang Yi(General Clinical Medical College,Fujian Medical University,Fuzhou 350025,China;Department of Hepatobiliary Surgery,the 900th Hospital of Chinese People's Liberation Army Joint Support Force,Fuzhou 350025,China)

机构地区：[1]福建医科大学福总临床医学院,福州350025 [2]中国人民解放军联勤保障部队第九〇〇医院肝胆外科,福州350025

出　　处：《中华器官移植杂志》2022年第7期390-395,共6页Chinese Journal of Organ Transplantation

基　　金：福建省自然科学基金(2020Y0078)。

摘　　要：目的探讨血小板-白蛋白-胆红素(platelet-albumin-bilirubin,PALBI)评分对肝癌肝移植受者术后肿瘤复发的预测价值。方法回顾性分析2010年1月至2020年12月中国人民解放军联勤保障部队第九〇〇医院确诊为肝细胞癌(以下简称肝癌)并接受肝移植治疗102例受者的临床资料。通过受试者工作特征(ROC)曲线、Kaplan-Meier法、单因素回归和多因素Cox回归分析等统计学方法,分析PALBI评分对肝癌受者肝移植术后肿瘤复发的预测价值及肝癌受者行肝移植术后肿瘤复发的危险因素。结果用ROC曲线分析确定术前PALBI评分预测复发的最佳截断值为-3.82,约登指数为0.317,ROC曲线下面积为0.679。以PALBI截断值-3.82为界分组进行生存分析,结果显示低水平PALBI组(78例)和高水平PALBI组(24例)术后1、3、5年肿瘤复发率分别为(17.9%比50.0%,26.9%比62.5%,29.5%比62.5%),两组比较,差异有统计学意义(均P<0.05)。单因素分析结果显示,受者术前肿瘤最大直径、肿瘤个数、是否符合米兰标准、AFP水平、有无微血管侵犯、有无门静脉癌栓、PALBI评分与术后肿瘤复发相关(均P<0.05)。多因素分析结果显示受者是否符合米兰标准、甲胎蛋白水平及PALBI评分是术后肿瘤复发的独立危险因素(均P<0.05)。结论术前PALBI评分对于肝癌肝移植受者术后肿瘤复发有一定的预测价值,当肝癌受者移植术前PALBI评分≥-3.82时,术后肿瘤复发率相对较高。Objective To explore the predictive value of platelet-albumin-bilirubin(PALBI)score for tumor recurrence after liver transplantation(LT)in patients with hepatocellular carcinoma(HCC).Methods Clinical data were retrospectively reviewed for 102 HCC patients undergoing LT from January 2010 to December 2020.The predictive value of PALBI score for tumor recurrence after LT and the risk factors for tumor recurrence after LT were examined by receiver operating characteristic(ROC)curve,Kaplan-Meier method and univariate/multivariate Cox regression.Results The optimal cutoff value of preoperative PALBI score for predicting recurrence was-3.82 with ROC curve,Youden's index 0.317 and area under the ROC curve 0.679.Survival analysis was performed using a PALBI cutoff value of-3.82 as boundary group.The results showed that significant differences existed in 1/3/5-year tumor recurrence rates(17.9%vs.50.0%,26.9%vs.62.5%,29.5%vs.62.5%)after low PALBI and high PALBI(P<0.05 for all).Univariate analysis indicated that preoperative tumor maximal diameter,tumor number,Milan criteria,alpha fetoprotein(AFP)level,microvascular invasion,portal venous tumor thrombus,and PALBI score were significantly associated with postoperative tumor recurrence(P<0.05 for all).And multivariate analysis revealed that Milan criteria,AFP level and PALBI score were independent risk factors for postoperative tumor recurrence(P<0.05).Conclusions Preoperative PALBI score offers some predictive value for postoperative tumor recurrence in HCC patients post-LT.When preoperative PALBI score≥-3.82 in HCC patients,postoperative tumor recurrence rate is relatively high.

关 键 词：肝移植 肝细胞癌 复发 

分 类 号：R735.7[医药卫生—肿瘤]