| Objective:Hepatocellular Carcinoma(HCC)is a malignant tumor with high morbidity and mortality,and liver transplantation(LT)is one of the most effective treatments for HCC.Donor resources of liver transplantation are precious and scarce,so it is of certain clinical significance to effectively predict the survival of patients with hepatocellular carcinoma after liver transplantation.The purpose of this study is to compare the predictive value of preoperative Albumin-Bilirubin score(ALBI),Child-Pugh grade of liver function,model for end-stage liver disease(MELD)and systemic immune-inflammatory index(SII)on the survival of HCC patients after LT,and to explore the risk factors affecting the survival of HCC patients after LT.Methods:This study included 263 HCC patients who underwent LT surgery from January 1,2014 to September 1,2020 in the Affiliated Hospital of Qingdao University for retrospective analysis.We collected basic information,laboratory indicators,surgical data,pathological data and survival time of patients.According to the corresponding indexes,calculate the preoperative ALBI score,Child-Pugh grade,model for end-stage liver disease(MELD)score and systemic immune-inflammatory index(SII).Calculate the preoperative ALBI score,Child-Pugh classification,MELD score,and SII of HCC patients according to the corresponding indicators,and the patients were divided into groups according to the best cut-off value of ALBI score,MELD score and SII index score model.The area under the ROC curve was calculated to evaluate the predictive value of ALBI score,ALBI grade,Child-Pugh grade,MELD score and SII on the prognosis of HCC patients undergoing LT surgery.The survival curve was drawn by Kaplan-Meier method for survival analysis,and the log-rank test was used to test the difference in survival rate between different groups.The above clinical data were firstly entered into the Cox proportional hazards regression model for univariate analysis affecting the survival time of HCC patients after LT,and the indicators with statistically significant differences were re-incorporated into the above model for multivariate analysis affecting the survival time of patients after LT.P <0.05 means the difference is statistically significant.Results:The area under ROC curve of ALBI score is 0.586,and the best cut-off value is-2.24;The area under ROC curve of Child-Pugh classification is 0.584;The area under the ROC curve of MELD score is 0.583,and the best cut-off value is 11;The area under ROC curve of SII is 0.678,and the best cut-off value is 488.13.The ALBI score,MELD score and SII were grouped according to the best boundary value.The 1-year,2-year,3-year and 5-year survival rates of HCC patients with low ALBI group were 96.0%,85.6%,80.8% and 80.8% respectively,while those with high ALBI group were 82.3%,72.0%,65.2% and 60.4% respectively,OS of HCC patients with low ALBI after LT was higher than that of patients with high ALBI(P=0.003).The 1-year,2-year,3-year and 5-year survival rates of patients with Child-Pugh A grade HCC after LT are 94.9%,82.2%,82.2% and 82.2% respectively,while those with Child-Pugh B grade HCC after LT are 86.8%,77.1% and 67.6%,and the 1-year,2-year,3-year and 5-year survival rates of Child-Pugh C grade HCC patients after LT were 64.7%,61.8%,61.8% and61.8% respectively(P = 0.017).The 1-year,2-year,3-year and 5-year survival rates of HCC patients with MELD≤11 group were 91.5%,79.5%,74.4% and 74.4% respectively,while those with MELD>11 group were 80.9%,73.3%,65.5% respectively(P = 0.052).The 1-year,2-year,3-year and 5-year survival rates of HCC patients in low SII group were 91.3%,84.2%,79.4% and 75.6% respectively,while those in high SII group were 76.1%,54.6%,44.1% and 44.1% respectively(P < 0.001).The results of multivariate analysis incorporating the Child-Pugh classification in the Cox proportional hazards regression model showed that AFP ≥400 ng/m L(HR=1.831,95%CI:1.113-3.001,P=0.017),blood loss≥2000m L(HR=3.343,95%CI:1.975-5.661,P<0.001),MVI positive(HR=2.738,95%CI:1.515-4.947,P=0.001)and SII>488.13(HR=3.108,95%CI:1.855-4.911,P<0.001)are independent risk factors of OS in HCC patients after LT.Results of multivariate analysis incorporating ALBI scores in Cox proportional hazards regression models showed that AFP≥400 ng/m L(HR=1.881,95%CI:1.143-3.094,P=0.013)and blood loss≥2000m L(HR=3.141,95%CI:1.851-5.333,P<0.001),MVI positive(HR=2.540,95%CI:1.400-4.608,P=0.002),SII>488.13(HR=2.872,95% CI:1.762-4.681,P<0.001)are independent risk factors for OS after LT in HCC patients.Survival analysis of ALBI score combined with SII in regrouping HCC patients undergoing LT surgery shows that the 1-year,2-year,3-year and 5-year cumulative survival rates of HCC patients in the low ALBI + low SII group after LT were 96.3%,87.3%,84.4%and 84.4%;the 1-year,2-year,3-year and 5-year cumulative survival rates of low ALBI +high SII group or high ALBI + low SII group were 88.9%,81.6%,74.4% and 68.9%respectively,while those with high ALBI + high SII group were 67.2%,44.1%,33.6% and33.6% respectively(P < 0.001).Conclusion:(1)Pre-operative ALBI score,Child-Pugh classification and SII index can predict the OS of HCC patients after LT,and the accuracy of SII index scoring model is better for OS in HCC patients after LT.MELD score cannot predict the OS of HCC patients after LT.(2)AFP≥400ng/m L,blood loss≥2000m L,MVI positive,SII>488.13 are independent risk factors for OS after LT in HCC patients.ALBI score is a predictor of OS after LT in HCC patients.(3)ALBI combined with SII has a certain predictive value for postoperative OS in patients with HCC LT. |
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