Albumin-bilirubin grade predicts prognosis in HCC
Albumin-bilirubin (ALBI) grade may predict prognosis in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE), a new study shows.
The study included 881 HCC patients receiving TACE (median age 68 years; 76 percent male) and showing a median overall survival of 24 months. Hepatitis B (35 percent, n=311) and C (27 percent; n=241), and alcoholism (19 percent; n=162) were the principal causes of HCC.
Of all the tested markers, ALBI grade resulted in the highest homogeneity (43.655) and lowest corrected Akaike information criteria (AICc) value (8,094.296). This was followed by cirrhosis discriminant index (CDS; 35.635 and 8,102.143, respectively) and Child-Turcotte-Pugh score (CTP; 26.861 and 8,111.090, respectively).
Univariate survival analysis showed that alcoholism (hazard ratio [HR], 1.240; 95 percent CI, 1.018 to 1.509; p=0.032), alkaline phosphatase level (HR, 1.678; 1.435 to 1.963; p<0.001), vascular invasion (HR, 2.511; 2.075 to 3.039; p<0.001) and ALBI grades 2 (HR, 1.678; 1.421 to 1.981; p<0.001) and 3 (HR, 1.501; 1.251 to 1.801; p<0.001) were all indicators of poor prognosis.
Multivariate analysis confirmed the significant association of alkaline phosphatase level (HR, 1.362; 1.155 to 1.607; p<0.001), vascular invasion (HR, 1.999; 1.622 to 2.464; p<0.001) and ALBI grade 2 (HR, 1.531; 1.285 to 2.823; p<0.001) to reduced survival.
ALBI grade 3 (HR, 1.525; 0.976 to 2.382l; p=0.064) was only modestly associated with poor survival.
Participants with histologically confirmed HCC were recruited from the Taipei Veterans General Hospitals.
Aside from ALBI, CTP and CDS, the prognostic performances of the following liver reserve markers were also assessed: aspartate transaminase-to-platelet ratio (APRI), fibrosis index based on four factors (FIB-4), Göteborg University Cirrhosis Index (GUCI), model for end-stage liver disease (MELD) and Lok index.