Refining Prognosis in Chemoembolization for Hepatocellular Carcinoma: Immunonutrition and Liver Function.

Lukas Müller,Peter Robert Galle,Michael Bernhard Pitton,Jens Mittler,Christoph Düber,Roman Kloeckner,Arndt Weinmann,Daniel Pinto Dos Santos,Felix Hahn,Aline Mähringer-Kunz,Fabian Stoehr,Simon Johannes Gairing,Friedrich Foerster

doi:10.3390/cancers13163961

Abstract

Simple SummaryThe combination of the albumin-bilirubin (ALBI) grading and the Prognostic Nutritional Index (PNI) offers potential as a highly predictive tool for patients with hepatocellular carcinoma (HCC). The present study evaluated this combination firstly for patients undergoing transarterial chemoembolization (TACE). Both the ALBI grade and PNI were strong independent predictors of survival. However, the combination of the two scores allowed for even more precise predictions. In addition, this new ALBI-PNI outperformed several established scoring systems. Thus, the easy-to-calculate ALBI-PNI may be a promising stratification tool for patients with HCC undergoing TACE in daily clinical routine.A combination of albumin-bilirubin (ALBI) grading and the Prognostic Nutritional Index (PNI) was identified recently as a highly predictive tool for patients with hepatocellular carcinoma (HCC) undergoing tumor ablation. The present study evaluated this combination in patients undergoing transarterial chemoembolization (TACE). Between 2010 and 2020, 280 treatment-naïve patients were retrospectively identified. The influence of ALBI grade, PNI and the novel ALBI-PNI on the median overall survival (OS) was assessed. In the next step, the prognostic ability of the combined approach was compared to established scoring systems. Both ALBI grade 2−3 and a low PNI were highly predictive for median OS (ALBI grade 1–3: 39.0 vs. 16.3 vs. 5.4 months, p < 0.001; high vs. low PNI: 21.4 vs. 7.5, p < 0.001). The combination of both resulted in a median OS of 39.0, 20.1, 10.3, and 5.4 months (p < 0.001). With a Concordance Index (C-Index) of 0.69, ALBI-PNI outperformed each individual score (ALBI 0.65, PNI 0.64) and was also better than BCLC, HAP, mHAP-II, and the Six-and-Twelve score (C-Indices 0.66, 0.60, 0.59, and 0.55). Thus, the easy-to-calculate ALBI-PNI may be a promising stratification tool for patients with HCC undergoing TACE, reflecting both immunonutritive status and liver function.

Highlights

Hepatocellular carcinoma (HCC) is one of the most common, and deadliest, cancers [1,2]
A low platelet count was associated with impaired survival (HR = 1.3, 95% confidence intervals (CIs) 0.9–1.7), but without reaching statistical significance in univariate analysis (p = 0.140)
We identified the Prognostic Nutritional Index (PNI) as the favorable immunonutritive scoring system for Western patients undergoing transarterial chemoembolization (TACE) [39]

Summary

Introduction

Hepatocellular carcinoma (HCC) is one of the most common, and deadliest, cancers [1,2]. Clinic Liver Cancer (BCLC) staging system is the preferred model for prognostication and treatment allocation [1,2]. According to this framework, TACE is the standard of care for patients with intermediate-stage cancer [3]. Several models for survival prediction and treatment stratification have been developed, but they all failed in external validation attempts [9,10,11,12,13,14,15,16,17,18,19,20,21].

Objectives

Methods

Discussion

Conclusion