Predictive Factors Determining Survival in Ambulatory Cirrhotic HCC Patients & Survival Analysis Using ALBI & Child Score

Abstract

Background and Aim: Identifying accurate prognostic indicators of overall survival (OS) in Hepatocellular carcinoma (HCC) allows care provider to counsel Individual patients and utilize optimum resources. In this study we aim to find out predictive factors determining survival in ambulatory cirrhotic HCC patients & further assess survival using ALBI & CHILD Score. Methods: In this observational study at MCH Thiruvananthapuram, All patients with diagnosis of HCC from January 2011 to December 2016 were studied who received standard of care and predictors of survival were studied with parameters measured before any treatment and within 6 weeks of diagnosis. A total of 202 were included and predictive factors in terms of OS were studied. Results: In our cohort of 202 cirrhotic patients, 164 were males and 38 were females. 43% were HBV related, 20% NASH and 17% Ethanol related. 36% CHILD A, 33% CHILD B and 30% CHILD C. 11%, 55% and 34% were ALBI grade 1, 2 and 3 respectively calculated using an online calculator by Stanford university, 13%, 27%, 28%, 31% were BCLC A, B, C and D respectively. 88% died on follow up. On Multivariate regression ALBI grade, CHILD status, Serum creatinine, serum albumin, INR, Serum Bilirubin, Platelet count, % Neutrophils were identified as factors affecting OS in HCC patients. Visual Inspection of the resulting Kaplain Meir survival curves shows equal good discrimination between the 3 ALBI groups & the CHILD grades. Median survival was 17, 6.6, 1.6 months in ALBI grade 1, 2 and 3 respectively & 10, 5, and 2 months in CHILD A, B and C respectively. Conclusion: ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting (Figure 1 and Table 1).Table 1Multivariate Cox Regression Analysis.VariableHRP-valueCIALBI Grade2.4230.0021.368–4.291CHILD PUGH STATUS1.370.050.991–2.328Serum creatinine1.5190.0550.991–2.328Serum Albumin0.3530.0000.212–0.588INR3.4540.0001.854–6.436Serum Bilirubin1.110.0011.043–1.182Platelet10.0151–1 Open table in a new tab The authors have none to declare.