Abstract No. 166 - Survival prognostication for HCC Patients undergoing radioembolization: ALBI grade versus Child-Pugh class

Abstract

The ALBI (albumin-bilirubin) grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function. In this study, we aim to evaluate the ALBI grading system as a prognostic indicator of overall survival in patients undergoing yttrium-90 radioembolization for unresectable hepatocellular carcinoma (HCC). With IRB approval, 948 HCC patients underwent radioembolization (2003-2016). Their baseline ALBI grade was recorded and compared to Child-Pugh (CP) class. Overall survival (OS) from time of 1st radioembolization was calculated using Kaplan Meier univariate analysis for ALBI grade, BCLC, and CP class. Multivariate analyses were performed using the Cox regression hazards model to evaluate BCLC, CP, and ALBI. ALBI 1, 2, and 3 grades were present in 63 (7%), 608 (64%), and 277 (29%) patients. The median OS in months (95% CI) for ALBI grades 1, 2, and 3 was 46.7 (30-47), 17.7 (16-21) and 9.1 (6.8-10.7), respectively (P<0.0001). Hazard ratios for OS for ALBI 2/3 compared to ALBI 1 were 2.7 (95%CI: 1.9-3.9) and 5.7 (95%CI: 3.8-8.5), respectively. The median OS in months (95% CI) for CP class A, B, & C was 21 (18-25), 11 (9.5-13) and 6 (4.4-16), respectively (P<0.0001). On sub-stratification analysis, in CP A patients, ALBI grade was further able to prognosticate survival with hazard ratios for ABLI >1 of 2.7 (95% CI: 1.7 to 4.2) compared to ALBI 1 (P = 0.017). In a multivariate analysis, hazard ratio for ALBI grade was 1.8 (95% CI: 1.41-2.3; P<0.0001). Hazard ratio for BCLC classification was 1.8 (95% CI: 1.67-2.06; P<0.0001), whereas that for CP was 0.9 (CI: 0.75-1.2; P = 0.5431). In patients within Milan criteria, multivariate analysis showed that ALBI grade significantly affected survival with a hazard ratio of 2 (95% CI: 1.15-3.5; P = 0.01) while CP class had a hazard ratio of 1.3 (95% CI: 0.7-2.5; P = 0.3). ALBI Grade, which is an objective method to assess liver function, provides a robust prognostic indicator of overall survival and may outperform CP class in HCC patients undergoing radioembolization.