Application of ALBI and PALBI score as prognostic variables in hepatocellular carcinoma patients treated with transarterial-chemoembolization.

Abstract

241 Background: Albumin-Bilirubin Score(ALBI) is simple prognostic tool to stratify HCC patients on liver function. It is proposed as more accurate predicting score of hepatic dysfunction compared with Child-Pugh (CP) grading. Platelet-Albumin-Bilirubin Score (PALBI) incorporating platelet count may offer further prognostic sensitivity. We sought to correlate ALBI, PALBI and CP grade with overall survival in HCC patients who underwent transarterial-chemoembolization (TACE). Methods: 431 HCC patients who received TACE between 2006 and 2012 at a Liver Centre, UK was included. Serum albumin, bilirubin and platelet were used to calculate ALBI and PALBI scores. Patients were classified into three groups using previously described formulas. Survival outcomes (Median OS) were measured using Kaplan-Meier method. Results: Median age of study population was 62 years. Patients classified by ALBI score, Group 1 was 208 patients (48%), 2 was 196 (45.4%) and 3 was 27 (6.3%). Median OS for Group 1 was 26.1 months (m) (95% CI 19.5-32.6), 2 was 18.6m (95% CI 14.9-21.5) and 3 was 11.7m (95% CI 6.1-17.3) (p < 0.001). PALBI Group 1 was 179 (41.5%), 2 was 150 (34.8%) and 3 was102 (23.7%). PALBI group 1 had median OS 25.5m (95% CI 17.9-33.1), 2 had 22.3m (95% CI 18.3-26.3), 3 had 10m (95% CI 5.9-14.3) (p < 0.001). Majority were class CP-A. (A = 365, B = 63, C = 2). CP-A patients were re-stratified on ALBI and PALBI status. ALBI Group 1 (N = 204) OS 26.0m (95% CI 19.5-32.6), 2 (N = 151) OS 19.1m (95% CI 14.7-23.5), 3 (N = 7) OS 7.6m (95% CI2.27-12.9) (p = 0.04). Survival of CP-A patients by PALBI was significantly different - Group1 (N = 175) OS 28.8m (95%CI 20.79-36.74), 2 (N = 140) OS 22.6m (95%CI 18.89-26.25) and 3 (N = 50) OS 8.9m (95%CI 6.25-11.5) (p < 0.001). Conclusions: Significant comparable survival difference was seen in ALBI and PALBI groups. CP-A patients with group 3 ALBI or PALBI had significantly poorer survival than groups 1 and 2 suggesting increased sensitivity determining hepatic dysfunction compared with CP status. Our results suggest ALBI and PALBI scores likely more accurate stratifying method for mild liver disease and guide treatment. Further prospective studies using both scores are warranted.