Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion

Abstract

Background:Transarterial chemo-embolisation (TACE) is recommended for patients with BCLC intermediate stage hepatocellular carcinoma (stage B), particularly in patients with good underlying liver function and minimal symptoms. The hepatoma arterial embolisation prognostic (HAP) score combines measures of liver function and tumour-related factors to offer a simple prognostic scoring system. The Albumin-Bilirubin (ALBI) grade permits assessment of the impact of liver function on survival. We aimed to investigate these two models and vascular invasion (VI).Methods:In an international cohort of 3030 patients undergoing TACE, we examined the impact of liver function as assessed by the ALBI score, the HAP score and VI on survival.Results:Classification according to ALBI grade resulted in non-overlapping survival curves in the overall data set and all regional cohorts. The HAP score was also validated. Tumour number, aetiology and VI were identified as additional independent prognostic risk factors not currently included in the HAP score. Survival was particularly poor for patients with VI.Conclusions:The ALBI grade categorised patients receiving TACE into three clear prognostic groups, thereby emphasising the importance of underlying liver function in the outcome of TACE. The HAP score has been validated internationally and the serious adverse impact of VI is clearly shown.

A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

“…The BCLC stage B subclassification system adopted Child‐Pugh score and up‐to‐7 criteria, whereas another newly proposed stage B subclassification system adopted Child‐Pugh class and up‐to‐11 criteria . More recent studies suggest that ALBI grade might be a better surrogate of liver function reserve in HCC patients undergoing various treatments, including TACE . The STATE score also included C‐reactive protein (CRP) values as a predictive marker, but CRP was not a routinely checked marker before TACE in clinical practice.…”

“…Recently, albumin‐bilirubin (ALBI) grade has been reported to be a simple discriminatory method for assessing liver function in HCC patients that eliminates the subjective variables required in the conventional Child‐Pugh system . Recent studies showed that ALBI grade could be a significant prognostic factor in HCC patients undergoing TACE, suggesting that ALBI grade could be incorporated into the prognostic model for HCC patients undergoing TACE . The aim of this study was to evaluate the prognostic value of ALBI grade and propose a new prognostic model based on ALBI grade for BCLC stage B HCC patients undergoing TACE.…”

The Prognosis of Single Large Hepatocellular Carcinoma Was Distinct from Barcelona Clinic Liver Cancer Stage A or B: The Role of Albumin-Bilirubin Grade

“…Moreover, serum albumin and bilirubin levels are the most critical factors to predict hepatic adverse events in cirrhotic patients. Recently, a new prognostic score, the ALBI score, has been validated as an objective, inexpensive, and feasible biomarker for liver function estimation and a reliable prognostic predictor across different BCLC stages and treatments for HCC [20, 21, 40-43]. In our cohort, we performed two multivariate analysis models to assess the independent risk factors predicting poor OS.…”

Differences in the impact of prognostic factors for hepatocellular carcinoma over time

“…AFP and DCP are established biomarkers for HCC and elevation of these markers reportedly reflects the progression of HCC from several aspects including size, number, and portal vein invasion, although some advanced HCC lack elevation of these markers. ALBI score is a recently proposed measure for liver function, and its reliability as a prognostic liver function marker have been reported in HCC with several degrees of progression . APRI and FIB‐4 index are also established laboratory indicators for the degree of liver fibrosis.…”

“…Several serum markers are associated with HCC progression, liver function, or liver fibrosis and, consequently, the prognosis of patients with HCC. They include tumor markers for HCC such as AFP and DCP for HCC progression, the recently reported ALBI score for liver function, and APRI and FIB‐4 index for liver fibrosis …”