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Research Progress on Prognostic Prediction Models After Radical Resection of Hepatocellular Carcinoma
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摘要: Child-Pugh分级和终末期肝病模型是术前评估肝细胞癌(hepatocellular carcinoma, HCC)患者根治性肝切除术后肝功能衰竭及整体临床转归的经典方法，但受白蛋白、腹水、血肌酐等因素的影响，二者的应用存在一定局限性。查阅国内外相关文献后发现，术前白蛋白-胆红素评分、血小板-白蛋白-胆红素评分、格拉斯哥预后评分以及新型预测模型在HCC患者肝切除术后肝功能衰竭及临床预后评估中具有良好的应用前景。本文将对常用的根治性肝切除术HCC患者预后模型进行介绍，并对其应用价值进行综述。Abstract: The classical Child-Pugh classification and the model for end-stage liver disease are now widely used in clinics for postoperative assessment of liver failure and prognosis in patients with hepatocellular carcinoma (HCC) treated with radical hepatectomy. However, there are limitations in the application of both methods due to factors such as albumin, ascites, and blood creatinine. A review of the relevant literature at home and abroad revealed that preoperative albumin bilirubin score, platelet albumin bilirubin score, Glasgow prognostic score and new predictive models have good application prospects in evaluating liver failure and prognosis of HCC patients after hepatectomy. In this paper, we aim to introduce the commonly used prognostic models for HCC patients undergoing radical hepatectomy and review the value of their application.作者贡献：张垚、赵成俊负责文献收集、论文撰写；杜磊、马倩源负责论文修订; 任宾负责拟定写作思路，指导论文撰写并最终定稿。利益冲突：所有作者均声明不存在利益冲突
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表 1 根治性肝切除术HCC患者预后预测模型总结
预测模型 组成参数及特征 适用情形描述 优点 缺点 Child-Pugh分级 包含腹水、肝性脑病、TBIL、ALB及凝血酶原时间5项指标，等级越高表示肝功能损伤越重 预测慢性肝病患者预后的经典分期系统，尤其适用于肝硬化患者，是进行肝移植和肝切除术的必要评估内容 可估计肝功能状态，使用方便，对肝病较轻的患者具有较好预测价值 部分指标主观性强、缺乏统一量化；存在内部等级差异进而影响预后的判断；对严重肝病的判断不精准 MELD评分 包含TBIL、Cr、INR及病因4项指标，评分越高表示肝功能损伤越重，预后不良的风险越高 预测非肝移植患者肝病相关死亡率，评价肝移植前患者等待供体的死亡风险并预测移植术后死亡率 目前最有效的终末期肝病模型之一，对终末期肝病短期、中期死亡率具有较好的预测价值 非肝病因素可影响组成参数的稳定性；不适用于肝功能损伤程度较轻者 ALBI评分 基于ALB和TBIL构建的等级评分，等级越高，预后不良的风险越大 评估肝病患者肝功能严重程度及术后并发症、预后风险 较全面地反映肝功能状况，可对同Child-Pugh等级患者进一步风险分层 组成参数较少，结果易存在偏倚；肝外因素可能影响等级的划分 PALBI评分 在ALBI的基础上新增了PLT指标，等级越高，预后不良的风险越大 同ALBI评分 相比ALBI评分，可更全面地反映肝功能状况；可对Child-Pugh A级患者进行更具体的风险分层 缺乏对Child-Pugh B~C级患者的预测价值验证 GPS评分 仅包含CRP、ALB 2项指标，赋值越大，预后不良的风险越高 多用于卵巢癌、胃癌等多种恶性肿瘤的预后评估 同时考虑炎症和营养状况，简单、快捷 HCC患者相关研究较少，性能有待验证 ALBI-FIB-4评分 将肝功能ALBI评分与肝纤维化FIB-4指数相结合的综合评分系统 目前仅报道用于HCC患者术后预后的评估 同时将肝功能及肝纤维化作为术后评估标准，性能优于单一ALBI评分、FIB-4指数 相关研究较少，性能尚待进一步验证 ALBI-APRI评分 将肝功能ALBI评分与肝纤维化APRI指数相结合的综合评分系统 目前仅报道用于HCC患者术后预后的评估 同时将肝功能及肝纤维化作为术后评估标准，性能优于单一ALBI评分、APRI指数 相关研究较少，性能尚待进一步验证 neo-GPS评分 将肝功能ALBI评分与炎症反应GPS评分相结合的综合评分系统 目前仅报道用于HCC患者术后并发症的评估 同时将肝功能及炎症、营养状况作为术后评估标准 相关研究较少，性能尚待进一步验证 HCC：肝细胞癌；TBIL：总胆红素；ALB：白蛋白；MELD：终末期肝病模型；Cr：肌酐；INR：国际标准化比值；ALBI：白蛋白-胆红素评分；PALBI：血小板-白蛋白-胆红素评分；PLT：血小板；GPS：格拉斯哥预后评分；CRP：C反应蛋白；FIB-4指数：纤维化-4指数；APRI：天冬氨酸氨基转移酶与血小板的比值 
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