白蛋白-胆红素-γ-谷氨酰转移酶评分与肝细胞癌患者预后相关性分析

摘要/Abstract

摘要： 目的：探讨基于白蛋白-胆红素（ALBI）评分和γ-谷氨酰转移酶（GGT）构建的ALBI-GGT评分预测肝细胞癌（HCC）患者术后预后的准确性。
方法：回顾性收集2018年3月至2023 年12 月内江市中医医院接受根治性肝切除术的154例HCC患者临床资料。通过单因素及多因素Cox比例风险回归模型分析患者预后相关因素。基于ALBI评分和GGT回归系数构建ALBI-GGT评分。采用一致性指数（C指数）、赤池信息准则（AIC）和贝叶斯信息准则（BIC）评估ALBI-GGT评分拟合优度和复杂性。使用Kaplan-Meier生存曲线及限制性立方样条分析ALBI-GGT评分与患者生存状态关系。使用受试者操作特征曲线（ROC曲线）及曲线下面积（AUC）评估ALBI-GGT评分预测患者术后1、3、5年死亡风险。
结果：154例HCC患者随访时间3.0~60.0个月,中位生存时间34.2个月,1、3、5年生存率分别为86.4%、49.6%、41.8%。单因素及多因素Cox模型分析显示ALBI评分与GGT是HCC患者术后死亡的独立危险因素（P<0.05）;似然比检验显示无显著交互作用（HR=1.136,P=0.091）,表明二者效应独立可叠加。ALBI-GGT评分（1.643×ALBI评分+0.755×GGT）的C指数、AIC和BIC值分别为0.813、703.636和706.102。高ALBI-GGT评分患者总生存率低于低评分组患者（P<0.05）。限制性立方样条模型拟合结果显示,ALBI-GGT评分存在显著的非线性关系（P<0.001）。ALBI-GGT评分预测患者术后1、3、5年死亡风险的AUC分别为0.820、0.917、0.924。
结论：ALBI-GGT评分能有效预测HCC根治性肝切除术患者预后,有助于实现更精细的术后风险分层与个体化管理。

关键词: 肝细胞癌, 白蛋白, 胆红素, γ-谷氨酰转移酶, 预后

Abstract: Objective:To investigate the accuracy of the albumin-bilirubin (ALBI) score combined with gamma-glutamyltransferase (GGT) in constructing an ALBI-GGT score for predicting postoperative prognosis in patients with hepatocellular carcinoma (HCC) undergoing curative liver resection.
Methods:Clinical data of 154 HCC patients who underwent curative liver resection from March 2018 to December 2023 were retrospectively collected. Univariate and multivariate Cox model analyses were performed to identify factors associated with patient prognosis. The ALBI-GGT score was constructed based on the regression coefficients of the ALBI score and GGT. The concordance index (C-index), Akaike information criterion (AIC), and Bayesian information criterion (BIC) were used to evaluate and compare the goodness-of-fit and complexity of the ALBI-GGT score. Kaplan-Meier survival curves and restricted cubic spline analysis were employed to examine the relationship between the ALBI-GGT score and patient survival status. Receiver operating characteristic (ROC) curve analysis with the area under the curve (AUC) was used to assess the ALBI-GGT score's ability in predicting the risk of postoperative death at 1, 3, and 5 years.
Results:The follow-up time for the 154 HCC patients ranged from 3.0 to 60.0 months, with a median survival time of 34.2 months. The 1-year, 3-year, and 5-year survival rates were 86.4%, 49.6%, and 41.8%, respectively. Univariate and multivariate Cox regression analyses identified both the ALBI score and GGT as independent risk factors for postoperative mortality in HCC patients (P<0.05). The likelihood ratio test indicated no significant interaction (HR=1.136, P=0.091), suggesting that the effects of the two factors are independent and additive.The ALBI-GGT score (1.643×ALBIs core+0.755×GGT) yielded C-index, AIC, and BIC values of 0.813, 703.636, and 706.102, respectively. The overall survival rate of patients with a high ALBI-GGT score was significantly lower than that of the low-score group (P<0.05). The restricted cubic spline model demonstrated a significant nonlinear relationship for the ALBI-GGT score (P<0.001). The score showed excellent predictive performance for postoperative mortality, with AUC of 0.820, 0.917, and 0.924 at 1, 3, and 5 years, respectively.
Conclusion:The ALBI-GGT score effectively integrates information related to liver function and tumor biology. It predicts the prognosis of HCC patients after curative liver resection more accurately than the ALBI score or GGT alone, and it is helpful for achieving more refined postoperative risk stratification and individualized management.

Key words: Hepatocellular carcinoma, Albumin, Bilirubin, Gamma-glutamyltransferase, Prognosis

陈燕, 陈丽, 倪金龙, 朱明芳, 李红兵. 白蛋白-胆红素-γ-谷氨酰转移酶评分与肝细胞癌患者预后相关性分析[J]. 肝癌电子杂志, 2026, 13(2): 9-17.

Chen Yan, Chen Li, Ni Jinlong, Zhu Mingfang, Li Hongbing. Correlation analysis between albumin-bilirubin-gamma-glutamyltransferase score and prognosis in patients with hepatocellular carcinoma[J]. Electronic Journal of Liver Tumor, 2026, 13(2): 9-17.

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