Abstract
PurposeThis work evaluated the prognostic performance of Child-Pugh (CP), albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) scores in hepatocellular carcinoma (HCC) patients undergoing radiotherapy (RT).ResultsThe study included 174 consecutive patients with 63% at CP A5 (n = 110) and 34% at CP A6 (n = 64). The median ALBI score was −2.39 (range: −3.61 to −1.41) with 34.5% at grade A1 (n = 60) and 65.5% at grade A2 (n = 114). The median PALBI score was −2.39 (range −3.39 to −1.24) with 33.3% at grade 1 (n = 58), 41.4% at grade 2 (n = 72) and 25.3% at grade 3 (n = 44). With a median follow-up of 21.7 months, the median OS of the entire cohort was 22.2 months. OS was significantly associated with the PALBI grade (p = 0.002) and for the ALBI grade (p = 0.00495), but not for the CP score (p = 0.46). The PALBI grade has a significantly higher AUC compared than the ALBI grade or CP scores in predicting OS. The PALBI grade was predictive of CP score decline ≥2 (20% grade 3 vs. 5.3% grade 1/2 p = 0.05) but the ALBI and CP scores were not.ConclusionAmong CP A HCC patients receiving radiotherapy, the PALBI and ALBI grade maybe a better prognostic tool than the CP score. The role of PALBI in predicting liver toxicity warranted further exploration.MethodsWe retrospectively reviewed HCC patients treated with individualized hypo-fractionated radiotherapy (IHRT) using stereotactic technique from 2006 to 2015. We collected CP, ALBI and PALBI scores prior to treatment and analyzed their correlation with overall survival (OS) and liver toxicity.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and ranks the second in malignancy-related mortality [1]
overall survival (OS) was significantly associated with the PALBI grade (p = 0.002) and for the albuminbilirubin score (ALBI) grade (p = 0.00495), but not for the CP score (p = 0.46)
The PALBI grade has a significantly higher AUC compared than the ALBI grade or CP scores in predicting OS
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and ranks the second in malignancy-related mortality [1]. The CP classification system was widely used for decades to assess patient hepatic function and has been widely adopted in the HCC staging system, management algorithm and clinical trials [5, 6]. The CP classification is limited by subjectivity in assessing hepatic encephalopathy and ascites, and interrelationships between the serum albumin level and ascites [7]. The albuminbilirubin score (ALBI) was recently proposed as a simple and objective assessment of liver function, in which the score is based solely on the serum albumin and bilirubin levels [8]. Based on the ALBI score, the platelet-albumin-bilirubin (PALBI) score was recently developed to account for the effect of portal hypertension, with the platelet count acting as a surrogate for portal hypertension severity [15]. A recent study found that PALBI and ALBI both have a better predicting power than the CP score in HCC patients receiving aggressive therapies [16]
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