Abstract No. 548 A score based on routine laboratory values as a prognosticator of survival in hepatocellular carcinoma

Abstract

To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with yttrium-90 radioembolization (Y90) and develop/validate a prognostic scoring system With IRB approval, we selected all patients that underwent Y90 for HCC with baseline alpha-fetoprotein (AFP)>100 ng/dl from our prospectively acquired database. Laboratory values [neutrophil-lymphocyte (N/L) (inflammatory-immune response), albumin-bilirubin (ALBI) grade (liver function), and AFP (tumor marker)] were measured at baseline and at 1-, 3-, and 6-month post-Y90 Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Three scoring systems were developed [Baseline Imaging Score (including PVT, metastases, ascites, portal hypertension); Laboratory Score (including ALBI and AFP)]. We divided patients into two groups (Predicting Group and Validating Group) to investigate and validate the predictability of these scoring systems. Time-dependent receiver operating characteristics (ROC) were evaluated. 345/401, 238/401, and 167/401 patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI score and AFP response were significant OS prognosticators at all Landmarks. Laboratory Score [ALBI+(0.3 × LnAFP)] was developed to predict OS from these Landmarks in the Predicting Group and was internally validated. Areas under the curve (AUC) of time dependent ROCs of the Baseline Imaging Score vs. Laboratory Score in predicting patient OS 1 month post-3 and 6-month Landmarks were 0.56 vs.0.82 and 0.57 vs.0.77, respectively; AUCs of predicting patient OS 3 months post-3 and 6 month Landmarks were 0.58 vs.0.72 and 0.55 vs.0.79, respectively. Post-therapeutic AFP response and ALBI scores are easily calculable values from routinely performed blood tests. Our proposed Laboratory Score combines post-therapeutic ALBI score with AFP response and is independent of imaging findings. Using time-dependent ROC, the Laboratory Score was a better prognosticator of OS than the Baseline Imaging Score.