血小板-白蛋白-胆红素评分对肝细胞癌患者肝切除术后教科书式结局的影响

李梅霞; 覃莉; 邱占成; 陈廷昊; 胥月晴; 李川

doi:10.12449/JCH250519

血小板-白蛋白-胆红素评分对肝细胞癌患者肝切除术后教科书式结局的影响

DOI: 10.12449/JCH250519

李梅霞^1a,
覃莉^1a,
邱占成^1b,
陈廷昊²,
胥月晴^1b,
李川^1b, , ,

1a.
四川大学华西医院胰腺外科，成都 610041
1b.
四川大学华西医院肝脏外科，成都 610041
2.
资阳市中心医院肝胆胰外科，四川资阳 641399

基金项目:

四川省自然科学基金 (2024NSFSC0637)

伦理学声明：本研究方案经由四川大学华西医院伦理委员会［批号：2024年审（1844）号］和资阳市中心医院伦理委员会［批号：2024年审（323）号］审批。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李川、李梅霞、覃莉负责课题设计，资料分析，撰写论文；李梅霞、覃莉、邱占成、陈廷昊、胥月晴参与收集数据，修改论文；李川负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李川， lichuan@scu.edu.cn （ORCID： 0000-0001-5450-6961）

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出版历程
- 收稿日期: 2024-09-21
- 录用日期: 2024-10-23
- 出版日期: 2025-05-25

Influence of platelet-albumin-bilirubin score on textbook outcome of patients with hepatocellular carcinoma after hepatectomy

Meixia LI^1a,
Li QIN^1a,
Zhancheng QIU^1b,
Tinghao CHEN²,
Yueqing XU^1b,
Chuan LI^{1b
, ,
,}

1a.
Department of Pancreatic Surgery，West China Hospital，Sichuan University，Chengdu 610041，China
1b.
Department of Liver Surgery，West China Hospital，Sichuan University，Chengdu 610041，China
2.
Department of Hepatopancreatobiliary Surgery，Ziyang Central Hospital，Ziyang，Sichuan 641399，China

Research funding:

Natural Science Foundation of Sichuan Province (2024NSFSC0637)

More Information

Corresponding author: LI Chuan， lichuan@scu.edu.cn （ORCID： 0000-0001-5450-6961）

摘要

摘要: 目的血小板-白蛋白-胆红素（PALBI）评分对肝细胞癌（HCC）患者肝切除术后获得教科书式结局（TO）的影响尚不清楚。拟探索术前不同PALBI评分分级与HCC患者肝切除术后获得TO的关系。方法回顾性收集四川大学华西医院和资阳市中心医院2013年1月—2022年1月行肝切除术的HCC患者资料。TO定义为无术后30 d内严重并发症、无90 d内患者死亡、无出院后30 d内再住院、无围手术期输血、R0切除、无住院时间延长。计数资料两组间比较采用χ²检验。单因素和多因素Logistic回归分析HCC患者肝切除术后获得TO的影响因素。采用Kaplan-Meier法绘制HCC患者生存曲线，并通过Log-rank检验进行比较。结果共3 599例患者纳入研究，其中2 369例（65.8%）患者获得TO。多因素Logistic回归分析结果显示，PALBI评分分级（PALBI 2级：OR=1.562，95%CI：1.308～1.864，P<0.001；PALBI 3级：OR=2.216，95%CI：1.463～3.359，P<0.001）是影响HCC患者术后获得TO的独立危险因素。随着PALBI分级增加，患者获得TO的比率降低。PALBI 1级、2级和3级患者获得TO的比率分别为70.2%、54.2%和38.4%，差异有统计学意义（χ²=106.295，P<0.001）。30 d内严重并发症发生率、术后90 d内患者病死率、出院后30 d内再住院率、围手术期输血率、住院时间延长率均随着PALBI评分分级的增加而增加（P值均<0.05）。获得TO患者术后1、3、5年无复发生存率分别为79.5%、60.6%和51.5%，总生存率分别为92.1%、80.0%和71.1%；未获得TO患者术后1、3、5年无复发生存率分别为68.5%、52.7%和46.2%，总生存率分别为83.3%、66.0%和57.1%。获得TO的患者无复发生存率和总生存率均显著好于未获得TO的患者（χ²值分别为18.936、79.371，P值均<0.001）。结论术前PALBI评分分级影响HCC患者肝切除术后获得TO，PALBI分级越高的患者术后越不易获得TO。通过术前PALBI评分评估，有利于早期发现术后并发症发生的高危人群，提早干预，加强围手术期管理，从而提高患者围手术期安全性和长期预后。
- 癌，肝细胞 /
- 血小板-白蛋白-胆红素评分 /
- 教科书式结局
Abstract: Objective To investigate the influence of platelet-albumin-bilirubin （PALBI） score on the textbook outcome （TO） of patients with hepatocellular carcinoma （HCC） after hepatectomy， as well as the association of different PALBI scores before surgery with the achievement of TO after hepatectomy in HCC patients. Methods A retrospective analysis was performed for the data of HCC patients who underwent hepatectomy in West China Hospital of Sichuan University and Ziyang Central Hospital from January 2013 to January 2022. TO was defined as no serious complication within 30 days after surgery， no death within 90 days， no rehospitalization within 30 days after discharge， no blood transfusion in the perioperative period， RO resection， and no prolongation of hospital stay. The chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for the achievement of TO after hepatectomy in HCC patients. The Kaplan-Meier method was used to plot the survival curves of HCC patients， and the Log-rank test was used for comparison. Results A total of 3 599 patients were included in this study， among whom 2 369 （65.8%） achieved TO. The multivariate Logistic regression analysis showed that PALBI grade （PALBI grade 2： odds ratio ［OR］=1.562， 95% confidence interval ［CI］： 1.308‍ ‍—‍ ‍1.864， P<0.001； PALBI grade 3： OR=2.216， 95%CI： 1.463‍ ‍—‍ ‍3.359， P<0.001） was an independent risk factor for achievement of TO after surgery in HCC patients. The proportion of patients achieving TO decreased with the increase in PALBI grade. Among the patients with PALBI grade 1， 2 or 3， the patients achieving TO accounted for 70.2%， 54.2%， and 38.4%， respectively （χ²=106.295， P<0.001）. The incidence rate of serious complications within 30 days， the mortality rate of patients within 90 days after hepatectomy， readmission rate within 30 days after discharge， perioperative blood transfusion rate， and the rate of prolonged hospital stay all increased with the increase in PALBI grade （all P<0.05）. For the patients achieving TO， the 1-， 3-， and 5-year relapse-free survival rates were 79.5%， 60.6%， and 51.5%， respectively， and the overall survival rates were 92.1%， 80.0%， and 71.1%， respectively； for those who did not achieve TO， the 1-， 3-， and 5-year relapse-free survival rates were 68.5%， 52.7%， and 46.2%， respectively， and the overall survival rates were 83.3%， 66.0%， and 57.1%， respectively. The patients who achieved TO had significantly better relapse-free survival rate and overall survival rate than those who did not achieve TO （χ²=18.936 and 79.371， both P<0.001）. Conclusion Preoperative PALBI grade can affect the achievement of TO after hepatectomy in HCC patients， and it is more difficult for patients with a higher PALBI grade to achieve TO. Preoperative PALBI score can be used to early identify the patients with a high risk of postoperative complications， provide early intervention， and enhance perioperative management， thereby improving the perioperative safety and long-term prognosis of HCC patients after hepatectomy.
- Carcinoma， Hepatocellular /
- Platelet-Albumin-Bilirubin Score /
- Textbook Outcome

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图 1 TO与非TO患者RFS及OS的比较

Figure 1. Comparison of recurrence-free survival and overall survival between TO and non-TO patients

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表 1 不同PALBI评分分级患者基线临床病理特征比较

Table 1. Comparison of the baseline clinicopathological characteristics of patients with different PALBI grades

项目	PALBI 1级（n=2 730）	PALBI 2级（n=757）	PALBI 3级（n=112）	χ²值	P值
男［例（%）］	2 314（84.8）	656（86.7）	98（87.5）	2.161	0.339
年龄>65岁［例（%）］	474（17.4）	130（17.2）	17（15.2）	0.364	0.834
AFP>400 ng/mL［例（%）］	939（34.4）	315（41.6）	59（52.7）	26.403	<0.001
PNI<45［例（%）］	247（9.0）	258（34.1）	75（67.0）	495.853	<0.001
HBV DNA阳性［例（%）］	1 025（37.5）	343（45.3）	67（59.8）	34.093	<0.001
肿瘤直径>5 cm［例（%）］	1 164（42.6）	451（59.6）	84（75.0）	104.069	<0.001
肝内多发肿瘤［例（%）］	276（10.1）	74（9.8）	19（17.0）	5.731	0.057
ALBI 2级［例（%）］	420（15.4）	489（64.6）	107（95.5）	966.901	<0.001
MVI阳性［例（%）］	936（34.3）	309（40.8）	62（55.4）	29.061	<0.001
肿瘤低分化［例（%）］	276（10.1）	113（14.9）	20（17.9）	18.493	<0.001
BCLC B/C期［例（%）］	433（15.9）	157（20.7）	32（28.6）	20.173	<0.001

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表 2 肝切除术后影响HCC患者获得TO的危险因素分析

Table 2. Risk factors affecting TO achievement in HCC patients after hepatectomy

项目	单因素分析			多因素分析
项目	OR	95%CI	P值	OR	95%CI	P值
男性	1.110	0.912～1.351	0.299
年龄>65岁	0.972	0.810～1.167	0.764
AFP>400 ng/mL	1.403	1.218～1.617	<0.001
HBV DNA阳性	1.089	0.946～1.253	0.234
血小板计数<50×10⁹/L	1.365	1.010～1.864	0.043	1.507	1.096～2.072	0.012
PNI<45	2.346	1.960～2.810	<0.001	1.696	1.387～2.073	<0.001
ALBI 2级	1.994	1.717～2.316	<0.001
肿瘤直径>5 cm	2.290	1.989～2.636	<0.001	1.889	1.622～2.200	<0.001
多发肿瘤	1.067	0.852～1.337	0.571
MVI阳性	1.712	1.486～1.973	<0.001	1.293	1.107～1.510	0.001
肿瘤低分化	1.244	1.006～1.538	0.044
BCLC分期（B/C vs 0/A）	1.848	1.550～2.202	<0.001	1.398	1.158～1.687	<0.001
PALBI 1级	1.000			1.000
PALBI 2级	1.992	1.689～2.349	<0.001	1.562	1.308～1.864	<0.001
PALBI 3级	3.777	2.558～5.576	<0.001	2.216	1.463～3.359	<0.001

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表 3 不同PALBI评分分级患者非TO指标情况的比较

Table 3. Comparison of each type of non-TO among patients with different PALBI grades

项目	PALBI 1级（n=2 730）	PALBI 2级（n=757）	PALBI 3级（n=112）	χ²值	P值
术后90 d内死亡	32（1.2）	21（2.8）	4（3.6）	12.688	0.002
非R0切除	108（4.0）	28（3.7）	6（5.4）	0.711	0.701
围手术期输血	151（5.5）	88（11.6）	28（25.0）	84.065	<0.001
术后30 d内严重并发症	123（4.5）	54（7.1）	18（16.1）	33.588	<0.001
出院后30 d内再住院	15（0.5）	7（0.9）	3（2.7）	7.806	0.020
住院时间延长	600（22.0）	269（35.5）	49（43.8）	77.574	<0.001

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