Abstract No. 520 Survival analysis using albumin-bilirubin grade for patients treated with drug-eluting bead transarterial chemoembolization (DEB-TACE) for hepatocellular carcinoma

Abstract

To compare the efficacy of the albumin-bilirubin (ALBI) grade classification system and Child-Pugh (CP) classification system in differentiating survival among patients with hepatocellular carcinoma (HCC) receiving drug-eluting bead transarterial chemoembolization (DEB-TACE). An IRB-approved, single-center retrospective review (January 2009–September 2016) found 303 patients with HCC who had received DEB-TACE (100-300μm LC Beads with 50 mg doxorubicin, BTG, West Conshohocken, PA) without concomitant locoregional therapy within 30 days. Clinical toxicities were recorded using criteria based on the Common Terminology Criteria for Adverse Events, Version 4.03a. Survival analysis was performed using Kaplan-Meier methods and censored for curative therapy. Survival curves were stratified based on albumin-bilirubin grade, Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) staging, presence of ascites and Eastern Cooperative Oncology Group (ECOG) performance status. Discriminatory ability of survival curves was calculated by C-index. Kaplan-Meier curves stratified by ALBI grade produced distinct, non-overlapping curves (p < 0.001) that showed greater discriminatory ability compared to CP class (C-index = 0.568, 0.545, respectively). Substratification of CP A by ALBI grade yielded distinct curves (p = 0.023). Analyses of measures of clinical decompensation (presence of ascites, ECOG greater than 0, CP B8 or greater) substratified by ALBI grade yielded distinct curves only for patients without clinical decompensation (p < 0.001, p < 0.001, p = 0.003, respectively). Substratification of BCLC by ALBI grade yielded greater discriminatory ability compared to substratification by CP class (C-index = 0.573, 0.565, respectively). Additionally for BCLC B patients, substratification by ALBI grade yielded distinct curves while CP class did not (p = 0.011, 0.379, respectively). ALBI grade shows improved discriminatory ability versus Child-Pugh class in differentiating overall survival among patients with hepatocellular carcinoma receiving DEB-TACE. Furthermore, ALBI grade was efficacious in substratifying survival among Child-Pugh A and BCLC B patients where CP class was not.