Evaluation of Pretreatment Albumin-Bilirubin Grade as a Better Prognostic Factor than Child-Pugh Classification in Hepatocellular Carcinoma Patients Administered Transarterial Chemoembolization Combined with Radiotherapy

Abstract

<h3>Purpose/Objective(s)</h3> This study evaluated the use of pretreatment albumin-bilirubin (ALBI) grade as a prognostic factor in hepatocellular carcinoma (HCC) patients receiving combined transarterial chemoembolization (TACE) and radiotherapy (RT). <h3>Materials/Methods</h3> Patients receiving RT following TACE between January 2011 and December 2020 were analyzed. The exclusion criteria were other biopsy-proven cancers than HCC, distant metastasis, double primary cancer requiring active treatment, history of abdominal RT, and an interval between TACE and RT of >24 weeks. A total of 73 patients were included. ALBI grade was defined as grade 1 (ALBI score ≤-2.60), grade 2 (ALBI score >-2.60 and ≤-1.39), or grade 3 (ALBI score >-1.39). The survival outcomes of patients according to ALBI grade and Child-Pugh (C-P) classification were measured by Kaplan–Meier analysis using log-rank tests. The potential prognostic factors were evaluated using Cox regression analysis. <h3>Results</h3> The median follow-up was 16.3 months (range, 3.6–107.5). Thirty-three (45.2%) and 40 patients (54.8%) were ALBI grades 1 and 2–3, while 64 (87.7%) and 9 (12.3%) were C-P classes A and B, respectively. The difference in the distribution of patients according to each grading system was statistically significant (<i>p=</i>0.003). The ALBI scores ranged from -3.29 to -0.89 (median -2.44). The median progression-free survival (PFS) and overall survival (OS) for ALBI grade 1 <i>vs.</i> 2–3 were 8.6 months <i>vs.</i> 5.0 months (<i>p</i>=0.016), and 27.0 months <i>vs.</i> 15.9 months (<i>p</i>=0.006), respectively. The median PFS and OS for C-P class A <i>vs.</i> B were 6.3 months <i>vs.</i> 6.1 months (<i>p</i>=0.265) and 24.8 months <i>vs.</i> 19.0 months (<i>p</i>=0.630), respectively. In multivariate Cox regression analysis, along with other clinically relevant variables such as age, performance status, tumor marker, C-P classification, and modified Union for International Cancer Control (mUICC) stage, ALBI grade 2–3 was statistically significantly associated with worse PFS and OS compared to ALBI grade 1 (<i>p</i>=0.035, hazard ratio [HR] 1.728, 95% confidence interval [CI] 1.038–2.875 for PFS; <i>p</i>=0.021, HR 2.161, 95% CI 1.124–4.156 for OS). Other than ALBI grade, only mUICC stage 4A was significantly associated with worse OS in multivariate analysis (<i>p</i>=0.009, HR 2.472, 95% CI 1.251–4.885). <h3>Conclusion</h3> These results suggested that ALBI grade could be a better survival probability indicator than C-P classification in patients treated by TACE combined with RT. As many clinical situations, such as vessel-invading HCC, require TACE and RT collectively, further validation of ALBI grade as a prognosticator under these circumstances is warranted.