Comparison of Modified Child-pugh (MCP), Albumin-bilirubin (ALBI), and Child-pugh (CP) score for predicting of survival in Hepatocellular Carcinoma Patients Treated with Transcatheter Arterial Chemoembolization

Development and validation of a prealbumin-bilirubin model for prognostic prediction in intermediate hepatocellular carcinoma undergoing transarterial chemoembolization

To establish and validate a novel prognostic model to predict outcomes for intermediate hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). Clinical data from intermediate-stage HCC patients who underwent TACE between January 2007 and December 2020 were retrospectively analyzed. Patients were divided into a training cohort and a validation cohort. Univariate and multivariate analyses identified risk factors associated with overall survival (OS), leading to the development of a predictive model. The model's accuracy, consistency, and clinical utility were validated both internally and externally and compared with the Albumin-Bilirubin (ALBI) grading, Platelet-Albumin-Bilirubin (PALBI) grading, Child-Pugh grading, mChild-Pugh grading, and the Model for End-Stage Liver Disease (MELD). A total of 737 intermediate-stage HCC patients were included, with 481 in the training cohort and 256 in the validation cohort. Multivariate analysis identified maximum tumor diameter, tumor number, prealbumin, and total bilirubin as independent factors for OS. A prealbumin-bilirubin (PABI) predictive model was developed. The PABI model's concordance indices (C-index) in the training and validation cohorts were 0.730 (95% CI 0.701-0.759) and 0.706 (95% CI 0.661-0.751), respectively. The area under the curve (AUC) values at 6, 12, 18, and 24 months in both cohorts were above 0.7. Among the six models, the PABI model had the highest C-index (0.713) and the lowest Akaike information criterion (AIC) value (5897.814) and the best performance in clinical decision curve analysis, suggesting better predictive performance and potential clinical utility. The PABI nomogram model appears to accurately predict survival in intermediate-stage HCC patients treated with TACE, providing clinicians with a valuable tool for candidate selection and prognosis stratification.

A New Prognostic Indicator for Biliary Tract Cancers: The ABIC Score

INTRODUCTION

Biliary tract cancers (BTC) comprise a heterogeneous group of malignancies, including gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. The main determinants of prognosis in BTC are the stage of the disease and the eligibility for curative treatment. Additionally, liver functional capacity is also one of the factors influencing survival in biliary tract cancers. The age-bilirubin-INR-creatinine (ABIC) score has been previously shown to predict prognosis in hepatic diseases. The aim of our study is to demonstrate the relationship between the ABIC score and prognosis in BTC.

MATERIALS AND METHODS

In this study, a retrospective analysis was performed on 41 patients with non-metastatic BTC and 73 patients with metastatic BTC who were followed up in our clinic between 2003 and 2025. All patients were ≥18 years old at the time of diagnosis, and BTC was pathologically confirmed. The ABIC score was calculated separately for each group. A threshold value for the ABIC score was determined using Receiver Operating Characteristic (ROC) analysis, and based on this threshold, patients were divided into low and high ABIC score groups. Both the relationship between the ABIC score and prognosis and the other factors affecting prognosis were investigated.

RESULTS

In the non-metastatic BTC group, the cutoff value for the ABIC score was 6.89. The median survival time of patients with a high ABIC score was significantly shorter. In the metastatic BTC group, the cutoff value for the ABIC score was 7.41. Similarly, in this group, patients with a high ABIC score had a significantly shorter median survival time. Additionally, in the non-metastatic BTC group, tumor localization and stage were prognostic factors affecting survival, while in the metastatic BTC group, CEA and first-line chemotherapy were the prognostic factors influencing overall survival. Conclusions: We demonstrate that the ABIC score is a prognostic factor determining median survival in both non-metastatic and metastatic BTC patients.

Predictors and risk factors of bile duct injury after transcatheter arterial chemoembolization for hepatocellular carcinoma

PURPOSE

Bile duct injury is a serious complication after transcatheter arterial chemoembolization (TACE). If it is not detected early and treated actively, it will not only affect the subsequent tumor-related treatment of hepatocellular carcinoma (HCC) patients, but also may lead to serious consequences such as infection, liver failure and even death. To analyze the risk factors of bile duct injury after TACE in patients with HCC and explore the predictive indicators of bile duct injury after TACE, which is helpful for doctors to detect and intervene early and avoid the occurrence of serious complications.

METHOD

We retrospectively analyzed the clinical data of 847 patients with primary hepatocellular carcinoma who underwent TACE for the first time in our interventional department. Patients were divided into two groups according to whether bile duct injury occurred after TACE: (1) bile duct injury group, N = 55; (2) no bile duct injury group, N = 792. The basic data, intraoperative conditions and the outcome of bile duct injury were analyzed. The chi-square test was used for comparison of enumeration data. The Mann-Whitney U test was used for comparison of measurement data. Risk factor analysis was performed using binary logistic regression analysis.

RESULTS

Basic data and intraoperative conditions were compared between the bile duct injury group and the group without bile duct injury: preoperative alkaline phosphatase (ALP) (103.24 ± 32.77U/L vs. 89.17 ± 37.35U/L, P = 0.003); history of hepatobiliary surgery (36.4% vs. 20.8%, P = 0.011); intraoperative lipiodol volume (P = 0.007); combined use of gelatin sponge particles (65.5% vs. 35.0%, P < 0.001); hypovascularity (58.2% vs. 24.5%, P < 0.001); and embolization site (P < 0.001). Comparison of postoperative liver function between bile duct injury group and non-bile duct injury group: postoperative total bilirubin (43.34 ± 25.18umol/L vs. 21.94 ± 9.82umol/L, P < 0.001); postoperative γ-glutamyltransferase(GGT) (188.09 ± 55.62U/L vs. 84.04 ± 36.47U/L, P < 0.001); postoperative ALP(251.51 ± 61.51U/L vs. 99.92 ± 45.98U/L, P < 0.001).

CONCLUSION

The dosage of lipiodol in TACE, supplementation of gelatin sponge particles, embolization site, and hypovascularity of the tumor are risk factors for biliary duct injury after TACE. After TACE, GGT and ALP increased ≥ 2 times compared with preoperative indicators as predictors of bile duct injury. Bile duct injury occurring after TACE can achieve good outcomes with aggressive management.

T1 relaxation time analysis in predicting hepatic dysfunction and prognosis in patients with HCC undergoing transarterial chemoembolization

OBJECTIVE

To evaluate the value of T1 mapping in predicting hepatic dysfunction and prognosis in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE).

MATERIAL AND METHODS

100 consecutive patients with treatment-naive HCC treated with TACE were prospectively analyzed. Clinical, laboratory, and MRI parameters (liver and tumor T1 relaxation times (T1L, T1T)) before and/or following TACE were measured and calculated. Clinical parameters included the Child-Turcotte-Pugh (CTP) classification, Barcelona Clinic Liver Cancer Classification (BCLC) criteria, and albumin-bilirubin (ALBI) score. Laboratory parameters were the gold standard for hepatic dysfunction. T1L and T1T were combined by stepwise multivariate logistic regression to yield a T1-related probability index (T1com) for further analysis. Study endpoints included hepatic dysfunction and progression-free survival (PFS) rate.

RESULTS

38 patients (38%) were diagnosed with hepatic dysfunction following TACE. There was no significant difference in clinical parameters between the groups with and without hepatic dysfunction. Logistic regression analysis showed that T1L and T1T were independent risk factors for assessing hepatic dysfunction. T1com showed a better AUC than T1L and T1T (0.81 vs. 0.76 and 0.69, P = 0.007 and 0.006). Patients with low T1com (≤0.42) showed a better median PFS than patients with high T1com (>0.42) (167.0 vs. 215.9 days, P = 0.010). In comparison, CTP, BCLC, and ALBI scores were not statistically significant in predicting PFS in HCC patients treated with TACE (P > 0.05).

CONCLUSION

Compared with widely used clinical parameters, T1 was more capable of predicting hepatic dysfunction after TACE. Stratification of patients with HCC undergoing TACE according to T1 may help clinicians to develop treatment strategies in preventing the occurrence of hepatic dysfunction and improving individual prognoses.

Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis

PURPOSE

Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies.

METHODS

Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software.

RESULTS

Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol-related liver disease were significant in the ALBI grade 3 group (P < 0.001).

CONCLUSIONS

High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.

Transarterial chemoembolisation plus I125 seeds implantation for people with unresectable hepatocellular carcinoma

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the benefits and harms of transarterial chemoembolisation (TACE) plus I125 seeds implantation compared with TACE alone, regardless of chemotherapeutic drugs and vascular occlusive agents, for people with unresectable hepatocellular carcinoma. 

Analysis of the albumin‐bilirubin score as an indicator of improved liver function among hepatitis C virus patients with sustained viral response after direct‐acting antiviral therapy

Background and Aim

To investigate the performance of the albumin‐bilirubin (ALBI) score as an indicator of improved hepatic function using a cohort of hepatitis C virus (HCV) patients with sustained viral response (SVR) after direct‐acting antiviral therapy (DAA).

Methods

HCV patients who achieved SVR after DAAs between 2015 and 2016 were followed for at least 24 months. Changes in ALBI were evaluated in the entire cohort and according to liver function and liver stiffness status at baseline.

Results

Four hundred ninety‐seven patients were enrolled. Exactly 96.92% were in Child–Pugh (CTP) class A, and 42% had grade 2 fibrosis. Median ALBI was −3.02, while 87.7 and 11.3% of patients were in ALBI grades 1 and 2, respectively. ALBI improved significantly over time, particularly in patients who had a worse ALBI at baseline. Exactly 77% of patients initially in ALBI grade 1 and 93.9% of those in ALBI grades 2–3 improved their ALBI score in different amounts. Improved ALBI was observed irrespective of CTP score at baseline. Median ALBI at baseline and after 24 months were −3.03 and −3.27 for CTP 5, 2.02 and −2.88 for CTP 6, and −1.59 and −2.84 for CTP >6. Similarly, a significant improvement in ALBI was observed within each stage of fibrosis at baseline.

Conclusion

ALBI was a good indicator of improved hepatic function in HCV patients with SVR after DAA therapy, able to identify changes even in those patients who started DAA therapy with well‐preserved function and mild fibrosis. This simple, objective, and noninvasive test should be evaluated in other clinical scenarios where liver function is relevant.

The Combination of Age, International Standardized Ratio, Albumin and γ-Glutamyl Transpeptidase (AIAG), Tumor Size and Alpha Fetoprotein (AFP) Stage as the Prognostic Model for Hepatitis B-Related Hepatocellular Carcinoma

Background

Advanced liver fibrosis can lead to cirrhosis, portal hypertension and liver failure. Besides, advanced liver fibrosis and cirrhosis are the major risk factors for hepatocellular carcinoma (HCC). Almost all patients with HCC also have liver cirrhosis. This study aims to predict the survival rate of hepatitis B-related hepatocellular carcinoma (HCC) by age, international standardized ratio, albumin and γ-glutamyl transpeptidase (AIAG), an indicator measuring the degree of cirrhosis.

Methods

A total of 501 hepatitis B-related HCC patients experiencing radical surgery were analyzed, retrospectively. General data about demographics and labs were collected at the date of diagnosis to calculate AIAG [age, international standardized ratio (INR), albumin and gamma-glutamyl transferase (GGT)]. The Kaplan–Meier curves and Cox analysis were used to evaluate overall survival (OS) and recurrence-free survival (RFS). The C-index was calculated in R software (version 4.0.3) to evaluate the accuracy of the prognostic model.

Results

During a median follow-up period of 30 months, 31.1% (156/501) of the patients died, and 34.3% (172/501) experienced the recurrence of HCC. Compared with patients with lower AIAG score, patients with higher AIAG score had higher Child-Pugh grade and were at higher Barcelona Clinic Liver Cancer (BCLC) stage (both P<0.05). Multivariate analysis suggested that GGT, alpha fetoprotein (AFP), tumor size, BCLC stage and AIAG grade were independent predictors of OS and RFS. Furthermore, the combined use of tumor size, AFP and AIAG stage could predict survival significantly better (C-index=0.710, 95% CI: 0.669–0.751) than BCLC stage.

Conclusion

AIAG is significantly associated with survival of HCC patients, and provides additional prognostic information for patients with HCC. Our findings suggest that the combination of AIAG, tumor size and AFP stage has a better predictive value for the prognosis of patients with hepatitis B-related hepatocellular carcinoma. However, it is necessary for more external evidences to determine clinical utility.