整合评分法（aCTA评分）对肝癌切除术后肝功能衰竭的预测价值

背景与目的：目前，有多种评估系统可用于肝癌预后指标的评估，均有各自的优势和局限性，而联合评估可能提高预测效能。因此，本研究探讨由年龄校正的查尔森合并症指数（aCCI）、肿瘤负荷评分（TBS）和白蛋白-胆红素（ALBI）评分构建的整合合并症情况、形态学特征、肝功能的联合评分（aCTA评分）对肝癌肝切除术后肝功能衰竭（PHLF）的预测价值。方法：回顾性收集武汉大学人民医院2020年1月—2023年2月236例行肝切除术的原发性肝癌患者的临床资料。根据患者术后1周是否出现肝功能衰竭，分为PHLF组（19例）和非PHLF组（217例）。通过单变量分析和多变量Logistic回归筛选PHLF的独立危险因素，并以受试者工作特征（ROC）曲线评估联合指标的预测效能。通过Framingham研究中心Logistic模型建立积分系统的方法构建PHLF的加权风险评分。采用一致性指数（C指数）、ROC曲线和校准曲线进行内部验证；采用决策曲线分析（DCA）评价该评分的临床实用性。结果：236例肝癌肝切除患者中19例（8.1%）发生PHLF。Logistc多变量分析结果显示，aCCI (OR=1.557,95%...

The predictive value of the integrated scoring method (aCTA score) for post-hepatectomy liver failure in liver cancer

Background and Aims Currently, there are multiple assessment systems available for evaluating prognosis indicators in liver cancer, each with its own strengths and limitations. Joint assessment may enhance predictive efficiency. Therefore, this study was conducted to investigate the predictive value of the combination of age-adjusted Charlson complication index (aCCI), tumor burden score (TBS), and albumin-bilirubin (ALBI) score (aCTA score), integrating complications, morphological features, and liver function, in predicting post-hepatectomy liver failure (PHLF). Methods The clinical data of 236 patients with primary liver cancer undergoing hepatectomy in Renmin Hospital of Wuhan University from January 2020 to February 2023 were retrospectively collected. Patients were divided into the PHLF group (19 cases) and non-PHLF group (217 cases) based on the occurrence of liver failure within 1 week after surgery. Univariate and multivariate Logistic regression analyses were conducted to identify the independent risk factors for PHLF. Receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of the combined indicators. A weighted risk score for PHLF was constructed using the Framingham Research Center Logistic model. Internal validation was performed using the concordance index (C-index), ROC curves, and calibration curve. The clinical utility of the score was assessed using decision curve analysis (DCA). Results Among the 236 patients undergoing liver resection for liver cancer, 19 cases (8.1%) developed PHLF. Multivariate Logistic regression analysis revealed that aCCI ( OR=1.557, 95% CI=1.014-2.391, P=0.043), TBS ( OR=1.214, 95% CI=1.022-1.442, P=0.027), and ALBI ( OR=5.387, 95% CI=1.844-15.733, P=0.002) were independent risk factors for PHLF in liver cancer patients (all P<0.05). The area under ROC (AUC) for aCCI, TBS, ALBI, and the combination of the three scoring systens were 0.662, 0.733, 0.768, and 0.822, respectively. Based on aCCI, TBS, and ALBI, the jointly constructed aCTA scoring system (with a maximum score of 10) had a C-index of 0.828 (95% CI=0.732-0.925). and the AUC was 0.809 ( P<0.05), indicating good discriminative ability. The calibration curve showed close agreement between predicted and observed values, suggesting good accuracy of the score. DCA demonstrated a net benefit for patients from the aCTA score model, indicating its good clinical applicability. Conclusion aCCI, TBS, and ALBI are independent risk factors for PHLF in liver cancer patients. The aCTA score, constructed based on them, has good predictive value and clinical guidance for high-risk patients.