ALBI评分联合RAR指标在肝细胞癌根治性切除术后预后评估中的价值

Prognostic value of combined albumin–bilirubin score and red blood cell distribution width-to-albumin ratio in patients with hepatocellular carcinoma after curative resection

    摘要
  • 摘要:
    目的 探讨红细胞分布宽度/白蛋白比值（red blood cell distribution width-to-albumin ratio，RAR）与白蛋白–胆红素（albumin–bilirubin，ALBI）评分联合（ALBI-RAR）在肝细胞癌（hepatocellular carcinoma，HCC）根治性切除术后复发风险预测中的价值，并比较其与单一指标的预测性能。
    方法 回顾性分析2013年1月至2023年12月在兰州大学第二医院接受肝切除术的257例HCC患者的临床资料，收集术前一般信息、实验室指标、肿瘤学特征及随访数据。通过受试者工作特征曲线（receiver operating characteristic curve，ROC）分析确定RAR的最佳截断值（3.245），并据此建立RAR分级及ALBI-RAR联合评分分组。以无复发生存期（recurrence-free survival，RFS）为终点，采用Kaplan–Meier法绘制生存曲线并行Log-rank检验，利用Cox比例风险回归分析复发的独立危险因素，并通过时间依赖性ROC曲线（最近邻估计法）评估预测性能。
    结果 单因素分析显示，肿瘤最大径、TNM分期、白蛋白水平、ALBI评分、RAR分级及ALBI-RAR联合评分均与术后复发显著相关（P<0.05）；多因素分析证实，ALBI-RAR 联合评分为术后复发的独立危险因素：与 1 级相比，4 级复发风险显著升高（HR = 14.6，95%CI：1.8~118.0，P = 0.012）。Kaplan–Meier分析显示联合评分在不同风险层级间的RFS区分最为明显（1～4级中位RFS为96、48、24和5个月，P<0.0001），优于单独的ALBI或RAR。36个月时，ALBI、RAR及ALBI-RAR的曲线下面积（area under the curve，AUC）分别为0.715、0.709和0.751，联合评分预测性能最高。
    结论 ALBI-RAR联合评分能够更准确地区分HCC根治性切除术后不同复发风险患者，预测性能优于单项指标，具有简便、客观且可重复的优势，可为术前风险评估及个体化随访策略制定提供有力依据。

     

    Abstract: Objective: This study aimed to evaluate the prognostic value of combining the red cell distribution width-to-albumin ratio (RAR) with the albumin–bilirubin (ALBI) score (ALBI–RAR) to predict postoperative recurrence risk in patients with hepatocellular carcinoma (HCC) after curative resection and compared its performance with each individual index. Methods: Clinical data of 257 patients with HCC who underwent curative hepatectomy at Lanzhou University Second Hospital from January 2013 to December 2023 were retrospectively reviewed. Preoperative demographic information, laboratory parameters, tumor features, and follow-up data were collected. The optimal RAR cutoff (3.245) was determined using receiver operating characteristic (ROC) analysis. Patients were stratified by ALBI score, RAR grade, and combined ALBI–RAR grade. Recurrence-free survival (RFS) was the primary endpoint. Kaplan–Meier survival curves with Log-rank testing compared RFS among groups, Cox proportional hazards regression identified independent predictors of recurrence, and time-dependent ROC curves (nearest neighbor estimation) assessed predictive performance. Results: Univariate analysis showed that maximum tumor diameter, TNM stage, albumin level, ALBI score, RAR grade, and ALBI–RAR grade were significantly associated with postoperative recurrence (P<0.05). Multivariate analysis confirmed the ALBI–RAR score as an independent predictor (grade 4 vs. grade 1: HR=14.6, 95% CI: 1.8–118.0, P=0.012). Kaplan–Meier analysis demonstrated that the combined score provided the clearest separation of RFS (median RFS: 96, 48, 24, and 5 months for grades 1–4, respectively; P<0.0001), outperforming ALBI and RAR alone. At 36 months, areas under the ROC curve were 0.715 for ALBI, 0.709 for RAR, and 0.751 for ALBI–RAR, indicating greater predictive accuracy for the combined score. Conclusion: The ALBI–RAR combined score more accurately stratifies recurrence risk in patients with HCC after curative resection. Its improved predictive performance and ease of use make it a practical tool for preoperative risk assessment and individualized postoperative surveillance planning.

     

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