Prognostic role of noninvasive liver reserve markers in patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Abstract

Background: Various noninvasive liver reserve markers were proposed to indicate the severity of liver damage. However, the role and feasibility of these markers to predict the prognosis of patients with hepatocellular carcinoma (HCC) are unknown. We aimed to identify the prognostic role of the 8 currently used hepatic reserve markers in patients with HCC undergoing transarterial chemoembolization (TACE).

Methods: Between 2002 and 2013, a total of 881 patients with HCC undergoing TACE were prospectively identified and retrospectively analyzed. The baseline characteristics, tumor status and noninvasive markers were collected. Homogeneity and corrected Akaike information criteria (AICc) were compared between these markers. The Cox proportional hazards model was used to identify independent predictors of survival.

Results: Significant differences in survival distribution were found for albumin-bilirubin (ALBI) grade, Child-Turcotte-Pugh (CTP) class, Lok index, fibrosis index based on 4 factors (FIB-4), Göteborg University cirrhosis index (GUCI), cirrhosis discriminant index (CDI) and model for end-stage liver disease (MELD) score (all p values <0.05). Among these markers, the ALBI grade showed the highest homogeneity and lowest AICc value, indicating a better prognostic performance. Cox multivariate analysis confirmed that ALBI grade 2, ascites, serum alkaline phosphatase and α-fetoprotein level, tumor diameter, vascular invasion and performance status were significant independent prognostic predictors. The distribution of the ALBI score well correlated with baseline CTP and MLED scores.

Conclusions: Our data suggest that among the currently used liver reserve markers, ALBI grade may serve as an objective and feasible surrogate to predict the prognosis of HCC patients undergoing TACE.

Fig 1. Comparison of survival distributions according to (A) ALBI, (B) APRI, (C) CTP, and (D) CDS grading.

Significant survival differences are found for ALBI grade, CTP class and CDS grading.

Fig 2. Comparison of survival distributions according to (A) FIB-4 index, (B) GUCI, (C) Lok index, and (D) MELD grading.

Significant survival differences are found in all 4 markers.

Fig 3. Correlation between ALBI score with CTP score and MELD score.

The ALBI score increases with increasing CTP and MELD scores. The dark line in the middle of the boxes is the median of ALBI score. The bottom of the box indicates the 25th percentile and the top of the box represents the 75th percentile. T-bar at the top and bottom of the box is maximum and minimum values, respectively. ○ indicates extreme values. SD; standard deviation.