Albumin/bilirubin grade (ALBI): a robust predictor of decompensation and poor outcome in high-risk patients undergoing TACE for HCC

Abdelrazek, Mohamed A; Lungren, M.; Hwang, Gloria L.; Wang, D; Louie, John D.; Kothary, Nishita

doi:10.1016/j.jvir.2016.12.787

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“…In our study, TACE was applied to patients with intermediate or advanced stages of disease. In these patients, albumin is an essential factor for the overall outcome and functions as a surrogate marker of therapy tolerance (42)(43)(44). Thus, the albumin component may be superior and outweigh the nutritional aspect in these patients, which could be underrepresented in the factor weighting in the CONUT score.…”

Section: Discussionmentioning

confidence: 99%

Immunonutritive Scoring in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Prognostic Nutritional Index or Controlling Nutritional Status Score?

et al. 2021

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ObjectivesThe Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score are immunonutritive scoring systems with proven predictive ability in various cancer entities, including hepatocellular carcinoma (HCC). We performed the first evaluation of the CONUT score for patients undergoing transarterial chemoembolization (TACE) and compared CONUT and PNI in the ability to predict median overall survival (OS).MethodsBetween 2010 and 2020, we retrospectively identified 237 treatment-naïve patients with HCC who underwent initial TACE at our institution. Both scores include the albumin level and total lymphocyte count. The CONUT additionally includes the cholesterol level. Both scores were compared in univariate and multivariate regression analyses taking into account established risk factors. In a second step, a subgroup analysis was performed on BCLC stage B patients, for whom TACE is the recommended first-line treatment.ResultsA high CONUT score and low PNI were associated with impaired median OS (8.7 vs. 22.3 months, p<0.001 and 6.8 vs. 20.1 months, p<0.001, respectively). In multivariate analysis, only the PNI remained an independent prognostic predictor (p=0.003), whereas the CONUT score lost its predictive ability (p=0.201). In the subgroup of recommended TACE candidates, both CONUT and PNI were able to stratify patients according to their median OS (6.6 vs. 17.9 months, p<0.001 and 10.3 vs. 22.0 months, p<0.001, respectively). Again, in the multivariate analysis, only the PNI remained an independent prognostic factor (p=0.012).ConclusionBoth scores were able to stratify patients according to their median OS, but only the PNI remained an independent prognostic factor. Therefore, PNI should be preferred when evaluating the nutritional status of patients undergoing TACE.

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Section: Discussionmentioning

confidence: 99%