Application Of Albumin-bilirubin Grading In The Treatment Of Advanced Extrahepatic Cholangiocarcinoma With Biliary Stents Combined With ¹²⁵I Seed Implantation

Objective Child-Pugh（CP）grading has been used to assess liver function and postoperative outcomes in biliary tract tumors.The purpose of this study was to explore the prognostic significance of another alternative liver function model,called albumin-bilirubin（ALBI）classification,in patients with advanced extrahepatic cholangiocarcinoma（EHC）treated with biliary stents combined with ¹²⁵I seed implantation.Methods From January 2012 to April 2018,128 patients with advanced EHC were enrolled in our department and received percutaneous transhepatic biliary stents combined with ¹²⁵I seed implantation.Preoperative clinical data were collected to assess CP and ALBI levels.The performance of ALBI score in predicting postoperative death was compared with that of CP score by using the（ROC）curve.Kaplan-Meier survival curve and Cox regression model were used to explore the factors influencing the overall survival rate of（OS）.Results The median survival time was 12 months,1-year and 2-year survival rates were 57.3%and 13.5%,respectively.The area under the ROC curve of the ALBI score used to predict death was significantly larger than that of the CP score（0.754,95%CI:0.658-0.850,P<0.001 vs.0.636,95%CI:0.519-0.753,P<0.001）.Univariate analysis showed that the factors associated with the overall survival of EHC were CA19-9,total bilirubin,albumin,ALBI grade and CP grade.In multivariate analysis,ALBI grade（HR=1.71,95%CI 1.10x 2.65,P=0.017）was an independent prognostic factor.Conclusion We demonstrate that ALBI grade can be used as a predictor of prognosis in patients with advanced EHC treated with biliary stents combined with¹²⁵I seed implantation.