Research Article: Comparing various scoring system for predicting overall survival according to treatment modalities in hepatocellular carcinoma focused on Platelet-albumin-bilirubin (PALBI) and albumin-bilirubin (ALBI) grade: A nationwide cohort study

Date Published: May 2, 2019

Publisher: Public Library of Science

Author(s): Soon Kyu Lee, Myeong Jun Song, Seok Hwan Kim, Misun Park, Ming-Lung Yu.

http://doi.org/10.1371/journal.pone.0216173

Abstract

We evaluated the ability of various grading scales including platelet-albumin-bilirubin (PALBI) and albumin-bilirubin (ALBI) grades to predict overall survival (OS) according to treatment modality in patients with hepatocellular carcinoma (HCC).

The cohort of 6,669 patients with HCC was selected randomly from the 2008–2012 national cohort of the Korean Central Cancer Registry. The OS of 6,507 of these patients was evaluated using the Child-Turcotte-Pugh (CTP) class, Model for End-stage Liver Disease (MELD) score, and ALBI and PALBI grades.

The patient’s mean age was 59.7 years. The most patients were hepatitis B virus (63.4%) and CTP class A (71.8%). The median OS durations of PALBI grade1 (38.4%), grade2 (33.2%), and grade3 (28.4%) patients were 81, 30, and 5 months, respectively (P<0.001). The PALBI grade had a larger area under the receiver operator characteristic curve (AUC) than did the CTP class, MELD score, and ALBI grade (overall AUC: 0.675 vs. 0.633, 0.645, and 0.642, respectively; P < 0.001). Moreover, the PALBI and ALBI grades enabled sub-classification of CTP A patients (P < 0.001). In a multivariate analysis, the PALBI and ALBI grades were significant risk factors for OS (P < 0.05). According to treatment modality, the PALBI grade was predictive of OS in patients receiving transarterial chemoembolization or supportive care. The ALBI grade was predictive of OS in patients undergoing surgical resection or radiofrequency ablation. The PALBI and ALBI grades are more reliable for accessing liver function and predicting OS in patients with HCC. Moreover, according to treatment modality, appropriate use of the ALBI and PALBI grades will enable accurate determination of the prognosis of patients with HCC.

Partial Text

Hepatocellular carcinoma (HCC) is a common type of cancer and a major cause of death worldwide [1]. Despite the development of new therapies, HCC remains difficult to treat because it typically occurs in advanced liver disease or cirrhosis [2]. Treatment decisions and prognosis prediction for patients with HCC are based on performance status, liver function, and tumor burden [3]. Thus, the evaluation of liver function is important in the management of HCC. The Child-Turcotte-Pugh (CTP) class and the Model for End-stage Liver Disease (MELD) score are used widely to assess liver function [4].

The Institutional Review Board of the Catholic University of Korea approved this study (DC17RESI097) and waived the requirement for informed consent. This study was conducted in accordance with the Declaration of Helsinki.

In this analysis of nationally representative data, we evaluated the ability of various scoring system focused on the ALBI and PALBI grades to predict the OS of patients with HCC. The ALBI and PALBI grades had higher AUC values than did the CTP class and MELD score. The ALBI and PALBI grades also showed good predictive performance for OS in patients with HCC. Moreover, each grade has different strength according to treatment modalities. Therefore, the ALBI and PALBI grades may be used to assess liver function and predict the survival of patients with HCC according to treatment modalities.

 

Source:

http://doi.org/10.1371/journal.pone.0216173

 

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