Abstract
PurposeTo establish albumin-bilirubin (ALBI) grade-based and Child-Turcotte-Pugh (CTP) grade-based nomograms, as well as to develop an artificial neural network (ANN) model to compare the prognostic performance and discrimination of these two grades for hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) combined with sorafenib as an initial treatment.MethodsThis multicenter retrospective study included patients from three hospitals between January 2013 and August 2018. In the training cohort, independent risk factors associated with overall survival (OS) were identified by univariate and multivariate analyses. The nomograms and ANN were established and then validated in two validation cohorts.ResultsA total of 504 patients (319, 61, and 124 patients from hospitals A, B, and C, respectively) were included. The median OS was 15.2, 26.9, and 14.8 months in the training cohort and validation cohorts 1 and 2, respectively (P = 0.218). In the training cohort, both ALBI grade and CTP grade were identified as independent risk factors. The ALBI grade-based and CTP grade-based nomograms were established separately and showed similar prognostic performance and discrimination when validated in the validation cohorts (C-index in validation cohort 1: 0.799 vs. 0.779, P = 0.762; in validation cohort 2: 0.700 vs. 0.693, P = 0.803). The ANN model showed that the ALBI grade had higher importance in survival prediction than the CTP grade.ConclusionsThe ALBI grade and CTP grade have comparable prognostic performance for HCC patients treated with TACE combined with sorafenib. ALBI grades 1 and 2 have the potential to act as a stratification factor for clinical trials on the combination therapy of TACE and systemic therapy.
Highlights
Due to its insidious onset, approximately 80% of patients with hepatocellular carcinoma (HCC) are first diagnosed with intermediate or advanced stage, which means that they are ineligible for curative therapies such as resection, transplantation, or ablation [1, 2]
The ALBI grade-based and CTP grade-based nomograms were established separately and showed similar prognostic performance and discrimination when validated in the validation cohorts (C-index in validation cohort 1: 0.799 vs. 0.779, P = 0.762; in validation cohort 2: 0.700 vs. 0.693, P = 0.803)
The artificial neural network (ANN) model showed that the ALBI grade had higher importance in survival prediction than the CTP grade
Summary
Due to its insidious onset, approximately 80% of patients with hepatocellular carcinoma (HCC) are first diagnosed with intermediate or advanced stage, which means that they are ineligible for curative therapies such as resection, transplantation, or ablation [1, 2]. For these patients, transarterial chemoembolization (TACE) is the major recommendation according to several international guidelines if they have preserved liver function and good performance status [3,4,5]. Apart from the study design, including the treatment duration of sorafenib and sequence of the combination treatment, the high heterogeneity of the included patients is the main reason contributing to the negative results of these RCTs [14,15,16,17]
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