A Better Survival Prediction Tool for Patients Undergoing TACE for HCC

Albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades can accurately predict survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma (HCC), according to a study published in the Journal of Vascular and Interventional Radiology.

The Child-Pugh scoring system is often used to stratify risk in patients with HCC before they are treated with locoregional therapy, but the predictive abilities of the Child-Pugh scoring system are limited by several variables, especially in patients with advanced disease. The ALBI tool was created to address these limitations and was further modified to result in the PALBI grade. Although these tools have both been validated externally multiple times, little data exists to assess their performance in high-risk patients undergoing transarterial chemoembolization.

To gather more data, researchers evaluated 180 high-risk patients in a single-center, retrospective study. The patients were categorized as high-risk based on laboratory abnormalities identified before the procedure, presence of ascites, encephalopathy, portal vein thrombus or transjugular intrahepatic portosystemic shunt, or Model for End-Stage Liver Disease score greater than 15.

Survival stratification was conducted with ALBI and PALBI grades with substratification by Child-Pugh class and Barcelona Liver Clinic Cancer stage using Kaplan-Meier analysis. The researchers used C-index to determine discriminatory ability and the accuracy of survival prediction.

Results showed that the median survival for 79 ALBI grade 2 patients was 20.3 months, and the survival for 101 ALBI grade 3 patients was 10.7 months. Thirty PALBI grade 2 patients survived for a median of 20.3 months, and 144 PALBI grade 3 patients survived for a median of 12.9 months.

When patients were substratified, there were distinct ALBI grade survival curves for Child-Pugh class B, Barcelona Liver Clinic Cancer stage A, and Barcelona Liver Clinic Cancer stage C. There were also distinct survival curves revealed for Barcelona Liver Clinic Cancer stage A via PALBI grade. Child-Pugh class showed distinct survival curves for the entire cohort, but these curves were not present after substratification by BCLC stage.

“Use of these scores in clinical practice may allow for improved risk stratification in this patient group; however, confirmation in larger scale prospective studies is warranted,” the study’s authors concluded.

Reference

Hansmann J, Evers MJ, Bui JT, Lokken RP, Lipnik AJ, Gaba RC, Ray CE Jr, et al. Albumin-bilirubin and platelet-albumin-bilirubin grades accurately predict overall survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol. 2017;28(9):1224-1231.e2