<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

Abstract

Background Platelet–albumin–bilirubin (PALBI) has been demonstrated to be superior to conventional Child–Pugh (C-P) grade in evaluating liver function and prognosis of HCC patients. However, both thrombocytosis and thrombocytopenia are unfavorable for HCC survival. The aim of this study was to preliminarily investigate the prognostic value of PALBI in HCC patients with thrombocytopenia and excluding thrombocytopenia. Methods In this retrospective cohort study, we reviewed 465 cases of HCC patients who underwent radical surgery. PALBI grade was calculated based on preoperative serological examinations. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), which were assessed by Kaplan–Meier method and Cox regression. The prognostic performances of PALBI and other models were estimated by using the concordance index (C-index). Results During a median follow-up time of 28 months, 31.6% (147/465) of patients died and 33.5% (156/465) experienced recurrence. Multivariate analyses revealed that both thrombocytosis and thrombocytopenia were independently associated with poor OS and RFS compared with normal platelet count (PLT) in HCC patients. Stratified analysis further revealed that PALBI was a significant predictor for HCC survival in patients excluding thrombocytopenia but not in patients with thrombocytopenia. In particular, in HCC patients excluding thrombocytopenia, the combination of tumor size with PALBI (C-index = 0.730, 95% CI: 0.674–0.786) may be superior to the classical Barcelona Clinic Liver Cancer (BCLC) and Cancer of Liver Italian Program (CLIP) staging systems in predicting survival. Conclusion In conclusion, PALBI grade, in particular the combination with tumor size, is an effective model for discriminating survival in HCC patients excluding thrombocytopenia but not in thrombocytopenic HCC patients.

Albumin‐bilirubin score is superior to platelet‐albumin‐bilirubin score and model for end‐state liver disease sodium for predicting posthepatectomy liver failure

“…However, our AUC with MELD‐Na (AUC = 0.63 and 0.64 for severe PHLF and 30‐day mortality, respectively) was greater than the values reported by Fagenson et al (AUC = 0.6 and 0.58 for severe PHLF and 30‐day mortality, respectively) potentially because we used the updated MELD‐Na formula 23 as opposed to the traditional MELD formula 14 . Hypoalbuminemia and hyperbilirubinemia are highly important objective surrogates for poor nutritional status, severe liver injury, and high risk of recurrence 20,32 . While the MELD‐Na score includes preoperative bilirubin level, the CTP scoring system includes both preoperative albumin and bilirubin level.…”

“…This study also showed no association between higher PALBI grades and development of severe PHLF, consistent with Xu et al 19 and Ye et al 16 PALBI had no statistical difference in predictive accuracy compared to MELD‐Na. Besides having a statistically robust equation, the proposed theory of better predictive power with PALBI comes from including blood platelet count, an indicator for the severity of preoperative portal hypertension, which is associated with higher rates of complications and survival after hepatic resection 18,20,28 . A lower platelet level is associated with worse portal hypertension 28 .…”

“…Unlike other studies on PALBI, we were unable to utilize CTP classification of patients for further subgroup comparisons of the scoring systems. Although including low platelet level in PALBI is reported to be a proxy for severity of portal hypertension, 18,20,28 hepatic portal venous gradient measurements or other proxy variables in NSQIP were not available to represent the degree of portal hypertension as a comparison. The presence of esophageal varices was once used as a surrogate for portal hypertension, but it is no longer available in NSIQP 33…”

“…The discriminatory power of the PALBI score to predict postoperative complications after hepatic resection over other conventional scoring systems remains unclear. While some data report no significant difference between the ALBI and PALBI scores in predicting severe PHLF, 16,19 others suggest the PALBI score is superior 15,17,18,20 . In addition, the majority of published studies on PALBI as a predictor for survival and severe PHLF were conducted in institutions outside the United States.…”

“…While some data report no significant difference between the ALBI and PALBI scores in predicting severe PHLF, 16,19 others suggest the PALBI score is superior. 15,17,18,20 In addition, the majority of published studies on PALBI as a predictor for survival and severe PHLF were conducted in institutions outside the United States. Differences in patient population and treatment approach in these studies may cause clinical outcomes to vary and question the applicability of these studies to the Western population.…”