Background: Liver function is a critical factor, both in the selection of treatment and in the prediction of prognosis in patients with hepatocellular carcinoma (HCC). The ALBI grade, introduced as a more objective method of assessing liver function, utilizes serum albumin (Alb) and total bilirubin (Bil) levels. Although albumin is widely recognized for its role in maintaining colloid osmotic pressure and regulating plasma volume, recent studies have implicated it in tumor progression, invasion, and metastasis. The purpose of this study is to determine the impact of serum albumin levels on overall survival (OS) and tumor invasion/metastasis in HCC patients with the same liver function (ALBI grade) at the time of diagnosis.Methods: In this study, 285 patients diagnosed with primary HCC at our institution from 2015 to 2019 were classified by ALBI grade and analyzed. Among them, 78 patients with ALBI grade 2 status were selected to evaluate the impact of albumin level. To further isolate the effect of albumin rather than bilirubin, patients in the ALBI grade 2 cohort were divided into two groups based on mean values of Alb (3.5 g/dL) and Bil (1.0 mg/dL). Alb normal group (Group A): Alb ≥ 3.5 g/dL, Bil ≥ 1.0 mg/dL (n = 42). Bil normal group (Group T): Alb < 3.5 g/dL, Bil < 1.0 mg/dL (n = 36). Liver function was almost the same in these two groups based on the ALBI grade. OS, progression-free survival (PFS), types of recurrence, and pathological findings were compared between the two groups. OS was analyzed by the log-rank test, and comparisons between the two groups were performed by thet-test and chi-square test, withp< 0.05 indicating statistical significance.Results: OS was significantly worse in Group T than in Group A before and after propensity score matching based on age, performance status, and HCC stage (p< 0.001 andp= 0.011). Among the 44 patients who received curative treatment (surgery or radiofrequency ablation), OS was also significantly worse in Group T (p< 0.001). An analysis of the recurrence patterns of 44 curatively treated patients revealed that Group T had significantly shorter PFS (p< 0.001), and all recurrence patterns were multiple (p= 0.002). Pathological analysis in 28 surgical patients showed that serosal invasion was present in significantly more patients in Group T (p= 0.003).Conclusions: Low serum albumin levels in patients with HCC indicate both liver dysfunction and increased tumor invasion and metastasis. Nutritional support and albumin supplementation may help reduce intrahepatic metastases and improve prognosis. Further studies are needed to explore the underlying mechanisms and therapeutic potential.
背景：肝功能是影响肝细胞癌（HCC）患者治疗方案选择及预后评估的关键因素。ALBI分级作为一种更客观的肝功能评估方法，采用血清白蛋白（Alb）和总胆红素（Bil）水平进行评估。尽管白蛋白在维持胶体渗透压和调节血浆容量方面的作用已获广泛认知，近期研究表明白蛋白还参与肿瘤进展、侵袭和转移过程。本研究旨在探讨诊断时肝功能（ALBI分级）相同的HCC患者中，血清白蛋白水平对总生存期（OS）及肿瘤侵袭/转移的影响。 方法：本研究纳入2015年至2019年在本机构确诊的285例原发性HCC患者，按ALBI分级进行分类分析。从中选取78例ALBI 2级患者评估白蛋白水平的影响。为排除胆红素干扰、单独分析白蛋白效应，将ALBI 2级队列按Alb均值（3.5 g/dL）和Bil均值（1.0 mg/dL）分为两组：白蛋白正常组（A组）：Alb ≥ 3.5 g/dL，Bil ≥ 1.0 mg/dL（n=42）；胆红素正常组（T组）：Alb < 3.5 g/dL，Bil < 1.0 mg/dL（n=36）。基于ALBI分级标准，两组肝功能水平基本相当。比较两组患者的OS、无进展生存期（PFS）、复发类型及病理学表现。采用对数秩检验分析OS，组间比较采用t检验和卡方检验，以p<0.05为统计学显著性。 结果：在根据年龄、体能状态和HCC分期进行倾向评分匹配前后，T组OS均显著差于A组（p<0.001和p=0.011）。在44例接受根治性治疗（手术或射频消融）的患者中，T组OS同样显著更差（p<0.001）。对44例根治治疗患者的复发模式分析显示，T组PFS显著缩短（p<0.001），且所有复发均为多发性（p=0.002）。28例手术患者的病理学分析表明，T组患者浆膜侵犯发生率显著更高（p=0.003）。 结论：HCC患者的低血清白蛋白水平不仅反映肝功能不全，同时提示肿瘤侵袭和转移风险增加。营养支持与白蛋白补充可能有助于减少肝内转移并改善预后。需进一步研究探讨其潜在机制及治疗潜力。
Impact of Serum Albumin Levels on Prognosis and Recurrence in Patients with Hepatocellular Carcinoma
肿瘤(癌症)患者之家