白蛋白-胆红素分级对经肝动脉化疗栓塞术治疗肝癌患者肝功能变化及其预后评估价值的Meta分析

余伟明; 洪文倩; 孙丙伦; 韩景钊; 脱红芳

doi:10.3969/j.issn.1001-5256.2021.11.018

白蛋白-胆红素分级对经肝动脉化疗栓塞术治疗肝癌患者肝功能变化及其预后评估价值的Meta分析

DOI: 10.3969/j.issn.1001-5256.2021.11.018

余伟明^{1, 2},
洪文倩¹,
孙丙伦^{1, 2},
韩景钊²,
脱红芳^2, ,

1.
华北理工大学研究生学院，河北唐山 063210
2.
河北省人民医院肝胆外科，石家庄 050051

详细信息

通信作者:
脱红芳，touhf@aliyun.com

中图分类号: R735.7
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出版历程
- 收稿日期: 2021-03-29
- 录用日期: 2021-04-20
- 出版日期: 2021-11-20

Value of albumin-bilirubin grade in predicting liver function changes and prognosis of hepatocellular carcinoma patients undergoing transarterial chemoembolization: A Meta-analysis

Weiming YU^{1, 2},
Wenqian HONG¹,
Binglun SUN^{1, 2},
Jingzhao HAN²,
Hongfang TUO^{2
, ,}

1.
Graduate School, North China University of Science and Technology, Tangshan, Hebei 063210, China
2.
Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang 050051, China

摘要

摘要: 目的分析白蛋白-胆红素(ALBI)分级对肝细胞癌(HCC)患者经肝动脉化疗栓塞术(TACE)后肝功能变化及其预后的评估价值。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、OVID、知网、万方、维普及中国生物医学文献数据库，收集所有关于ALBI分级对TACE治疗HCC患者肝功能变化及其预后评估的相关性研究，检索时间为数据库建立至2020年12月。对纳入文献进行质量评价及数据提取后，采用RevMan 5.3软件进行Meta分析。各研究间的异质性采用χ²检验判断；用HR或OR及其对应的95%CI评价结局指标；通过漏斗图评价发表偏倚。结果共纳入18篇文献，9940例患者。Meta分析结果显示：较高ALBI等级的HCC患者TACE后总生存期(OS)短于较低ALBI等级患者(2^nd vs 1^st：HR=1.48，95%CI：1.39~1.57，P＜0.000 01；3^rd vs 1^st：HR=2.45，95%CI：1.92~3.13，P＜0.000 01；3^rd vs 2^nd：HR=1.91，95%CI：1.71~2.13，P＜0.000 01)。2次TACE累积导致的ALBI恶化程度高于1次TACE(OR=1.91，95%CI：1.27~2.88，P＜0.05)，3次TACE累积导致的ALBI恶化程度高于1次TACE(OR=3.21，95%CI：1.95~5.28，P＜0.05)，3次TACE累积导致的ALBI恶化程度高于2次TACE(OR=1.70，95%CI：1.07~2.70，P＜0.05)。此外，ALBI可以预测TACE后慢加急性肝衰竭(ACLF)的发生(OR=4.57，95%CI：2.76~7.57，P＜0.000 01)。结论重复TACE治疗可导致肝功能持续恶化，并且ALBI分级对于评估TACE的预后及预测ACLF发生风险具有重要临床价值。
- ALBI分级 /
- 癌, 肝细胞 /
- 化学栓塞, 治疗性 /
- 预后 /
- Meta分析(主题)
Abstract: Objective To investigate the value of albumin-bilirubin (ALBI) grade in evaluating liver function changes and prognosis of hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). Methods PubMed, the Cochrane Library, EMbase, Web of Science, OVID, CNKI, Wanfang Data, VIP, and CBM databases were searched for studies on ALBI grade for evaluating liver function changes and prognosis of HCC patients undergoing TACE published up to December 2020. After quality assessment and data extraction, RevMan 5.3 was used to perform a meta-analysis of the studies included. The chi-square test was used to evaluate heterogeneity between studies; hazard ratio (HR)/odds ratio (OR) and corresponding 95% confidence interval (CI) were used to evaluate outcome measures; funnel plots were used to assess publication bias. Results A total of 18 articles were included, with 9940 patients in total. The meta-analysis showed that the HCC patients with higher ALBI grades after TACE had a shorter overall survival time than those with lower ALBI grades (2^nd vs 1^st: HR=1.48, 95%CI: 1.39-1.57, P < 0.000 01; 3^rd vs 1^st: HR=2.45, 95%CI: 1.92-3.13, P < 0.000 01; 3^rd vs 2^nd: HR=1.91, 95%CI: 1.71-2.13, P < 0.000 01). The degree of deterioration of ALBI caused by 2 times of TACE was higher than that caused by 1 time of TACE (OR=1.91, 95%CI: 1.27-2.88, P < 0.05); the degree of deterioration of ALBI caused by 3 times of TACE was higher than that caused by 1 time of TACE (OR=3.21, 95%CI: 1.95-5.28, P < 0.05); the degree of deterioration of ALBI caused by 3 times of TACE was higher than that caused by 2 times of TACE (OR=1.70, 95%CI: 1.07-2.70, P < 0.05). In addition, ALBI grade could predict the onset of acute-on-chronic liver failure (ACLF) after TACE (OR=4.57, 95%CI: 2.76-7.57, P < 0.000 01). Conclusion Repeated TACE treatment can cause continuous deterioration of liver function based on ALBI, and ALBI has an important clinical value in predicting prognosis and the risk of ACLF after TACE.
- ALBI Grade /
- Carcinoma, Hepatocellular /
- Chemoembolization, Therapeutic /
- Prognostic /
- Meta-Analysis as Topic

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图 1 文献检索流程

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图 2 ALBI与OS的关系(2^nd vs 1^st)

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图 3 ALBI与OS的关系(3^rd vs 1^st)

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图 4 ALBI与OS的关系(3^rd vs 2^nd)

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图 5 ALBI变化与重复TACE次数的关系(2次vs 1次)

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图 6 ALBI变化与重复TACE次数的关系(3次vs 1次)

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图 7 ALBI变化与重复TACE次数的关系(3次vs 2次)

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图 8 ALBI与TACE术后发生ACLF的关系

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图 9 ALBI与OS关系的漏斗图

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表 1 纳入文献基本特征表

第一作者及年份	国家	研究合作	样本量(例)	男/女(例)	ALBI分级	结局指标	HR/OR(95%CI)	提取方式	质量等级
Ho等^[13]2017	中国	单中心	881	673/208	Ⅰ~Ⅲ	OS	2^nd vs 1^st：1.531(1.285~1.823)，3^rd vs 1^st：1.525(0.976~2.382)	R(M)	A
Waked等^[14]2017	埃及	多中心	3030	2769/261	Ⅰ~Ⅲ	OS	Europe 2^nd vs 1^st：1.48(1.28~1.71)，3^rd vs1^st：2.59 (1.99~3.38)，3^rd vs 2^nd：1.63(1.28~2.06) Japan 2^nd vs 1^st：1.37(1.01~1.87)，3^rd vs 1^st：2.66 (1.77~4.00)，3^rdvs2^nd：1.99(1.58~2.51) Egypt 2^nd vs 1^st：1.43(1.10~1.86)，3^rd vs 1^st：2.77 (2.00~3.84)，3^rd vs 2^nd：2.15(1.74~2.65) China 2^nd vs 1^st：1.21(0.71~2.05)，3^rd vs 1^st：4.54 (1.71~12.05)，3^rd vs 2^nd：2.90(1.51~5.57)	E(U)	B
Zhao等^[15]2020	中国	单中心	221	194/27	Ⅰ~Ⅱ	OS	2^nd vs 1^st：1.83(1.22~2.74)	E(U)	B
Kim等^[16]2018	韩国	单中心	476	381/95	Ⅰ~Ⅲ	OS	2^nd vs 1^st：1.77(1.37~2.30)，3^rd vs 1^st：7.11 (3.98~12.7)	R(M)	B
Na等^[17]2018	韩国	单中心	905	-	Ⅰ~Ⅲ	OS	2^nd vs 1^st：1.40(1.15~1.71)，3^rd vs 1^st：2.02 (1.48~2.75)，3^rd vs 2^nd：1.64(1.26~2.14)	E(U)	B
Zhong等^[18]2019	中国	多中心	548	448/100	Ⅰ~Ⅲ	OS	2^nd vs 1^st：1.193(0.964~1.476)，3^rd vs 1^st：1.922(1.180~3.132)	R(M)	B
Carling等^[19]2019	挪威	单中心	49	38/11	I~II	OS	2^nd vs 1^st：1.13(0.52~2.46)	E(U)	B
王哲轩等^[20]2020	中国	单中心	185	159/26	Ⅰ~Ⅱ	OS	2^nd vs 1^st：1.82(1.29~2.59)	R(M)	A
刘芳等^[21]2020	中国	单中心	129	104/25	I~III	OS	2^nd vs 1^st：1.54(0.49~4.80)，3^rd vs 1^st：4.74 (1.14~19.71)，3^rd vs 2^nd：3.36(1.27~8.89)	R(M)	B
黄海等^[22]2019	中国	单中心	119	88/31	I~III	OS	2^nd vs 1^st：1.67(1.06~2.63)，3^rd vs 1^st：2.47 (1.53~3.99)	R(M)	A
张争运等^[23]2019	中国	单中心	233	198/35	I~II	OS	2^nd vs 1^st：1.29(0.94~1.77)	E(U)	B
Lee等^[24]2019	韩国	单中心	1715	1470/440	Ⅰ~Ⅲ	OS	2^nd vs 1^st：1.55(1.34~1.79)，3^rd vs 1^st：1.39 (1.02~1.89)	R(M)	B
Hansmann等^[25]2017	美国	单中心	180	142/38	Ⅱ~Ⅲ	OS	3^rd vs 2^nd：1.82(1.19~2.79)	E(U)	A
Hiraoka等^[26]2017	日本	单中心	212	163/49	Ⅰ~Ⅱ	肝功能恶化	2次TACE vs 1次TACE：2.08(1.06~4.05) 3次TACE vs 1次TACE：3.32(1.72~6.40) 3次TACE vs 2次TACE：1.60(0.87~2.92)	E(U)	B
Saito等^[27]2020	日本	单中心	113	84/29	Ⅰ~Ⅱ	肝功能恶化	2次TACE vs 1次TACE：1.66(0.76~3.64) 3次TACE vs 1次TACE：3.08(1.44~6.57) 3次TACE vs 2次TACE：1.85(0.90~3.80)	E(U)	A
魏庭丰等^[28]2020	中国	单中心	110	72/18	Ⅰ~Ⅱ	肝功能恶化	2次TACE vs 1次TACE：1.23(0.35~4.35)(Long-term) 2次TACE vs 1次TACE：2.38(1.03~5.45)(Short-term)
谢雪焜等^[29]2020	中国	单中心	711	628/83	Ⅰ~Ⅱ	ACLF	4.919(2.633~9.188)	R(M)	A
Mohammed等^[30]2018	德国	单中心	123	81/42	Ⅱ~Ⅲ	ACLF	3.99(1.70~9.40)	R(M)	B
注：E(U)，估计值(单变量)；R(M)，报告值(多变量)；OS，总生存期；2^nd vs 1^st，ALBI 2 vs ALBI 1；3^rd vs 1^st，ALBI 3 vs ALBI1；3^rd vs 2^nd，ALBI 3 vs ALBI 2。

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表 2 Meta分析结果

分析	研究数目	合并的HR(95%CI)	P值	异质性
分析	研究数目	合并的HR(95%CI)	P值	I²值	P值
研究区域
China	5	2.09(1.62~2.70)	＜0.001	35%	0.190
Korean	3	2.01(1.63~2.46)	＜0.001	92%	＜0.001
Japan	1	2.66(1.77~4.00)	＜0.001	-	-
Egypt	1	2.77(2.00~3.84)	＜0.001	-	-
Europe	1	2.59(1.99~3.37)	＜0.001	-	-
样本量
＜400	3	2.90(1.90~4.43)	＜0.001	0	0.370
＞400	6	2.24(1.97~2.54)	＜0.001	78%	＜0.001
HR提取方式
E(U)	6	2.54(2.17~2.96)	＜0.001	0	0.480
R(M)	5	1.95(1.61~2.37)	＜0.001	84%	＜0.001

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