Prognostic Value of Platelet-Albumin-Bilirubin Grade in Child-Pugh A and B Patients With Hepatocellular Carcinoma: A Meta-Analysis

Platelet-albumin-bilirubin versus albumin-bilirubin as a predictor of long-term survival for hepatitis B-Induced hepatocellular carcinoma after hepatic resection

BACKGROUND

The Child-Pugh (CP) score is widely used to evaluate the severity of liver dysfunction in patients with hepatocellular carcinoma (HCC). Recently, both the albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade have been raised to be objective measurement indexes of liver function which can sufficiently stratify HCC patient survival. In this study, we aim to compare the ability of albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade to predict outcomes in hepatitis B-Induced HCC after liver resection with curative intent.

METHODS

Between April 2013 and April 2023, 1005 consecutive hepatitis B-Induced HCC patients who underwent liver resection were included in this study. The performance of PALBI and ALBI score in predicting long-term survival was evaluated.

RESULTS

The area under the ROC curve (AUC) of the PALBI(AUC:0.618) for predicting long-term survival was greater than that of the ALBI(AUC:0.522). In the multivariate analysis for OS, both the ALBI (HR: 1.246 95%CI: 1.029-1.508 P = 0.024) and PALBI (HR: 1.207 95%CI: 1.049-1.388 P = 0.009) scores were identified as independent predictors of OS in HCC patients. In the univariate analysis for DFS, the PALBI grade was also significantly associated with poor DFS (P = 0.041). In contrast, the ALBI grade was not found to be significantly associated with poor DFS (P = 0.414). Subgroup analysis also showed, among patients across each BCLC stage, the group with ALBI grade 1 had DFS similar to that of the group with ALBI grade 2 (both P > 0.05). However, the PALBI grade can differentiate each BCLC stages into three prognostic groups (all P < 0.05).

CONCLUSION

Compared to ALBI grade, the PALBI grade is more clinically feasible and has better prognostic ability regardless of the grade of BCLC stage.

Association of albumin-bilirubin grade with survival outcomes in patients with cholangiocarcinoma

BACKGROUND

Numerous studies have reported the association between preoperative albumin-bilirubin (ALBI) grade and survival outcomes in patients with cholangiocarcinoma (CCA). However, the results are inconsistent. Therefore, we conducted a meta-analysis to comprehensively evaluate the relationship between ALBI grade and prognosis of CCA patients.

METHODS

We retrieved the databases (Pubmed,Embase and Web of science) to search articles about the association of ALBI grade with prognostic value in CCA patients. Hazard ratios (HR) and 95% confidence intervals (CI) were used to summarize survival outcomes. STATA 12.0 was used to implement the data analyses.

RESULTS

11 studies from 10 articles comprising 2841 patients were included in the meta-analysis. The pooled results showed that high ALBI grade was significantly associated with poor overall survival (OS) (HR: 1.75, 95% CI: 1.32-2.31) and relapse-free survival(RFS)(HR:1.95;95%CI:1.37-2.13). Subgroup analysis further showed that high ALBI grade had better predictive value for Asian population(HR:1.92;95%CI:1.46-2.51). Sensitivity analysis indicated that the results of the meta-analysis were stable.

CONCLUSIONS

High ALBI grade predicted adverse survival outcomes in CCA patients. ALBI grade may be an efficient and convenient prognostic indicator in CCA patients for Asian population.

The EZ-ALBI and PALBI scores contribute to the clinical application of ALBI in predicting postoperative recurrence of HCC

This research intends to assess the variance between EZ-ALBI and PALBI in forecasting recurrence following the resection of hepatocellular carcinoma (HCC). A retrospective analysis was conducted using clinical data from 522 HCC patients across two medical institutions. The study analyzed albumin-bilirubin values (ALBI), along with the Easy albumin-bilirubin values (EZ-ALBI) and the Platelet-albumin-bilirubin values(PALBI), while assessing the clinical traits of patients across various grades. The analysis focused on the connections between ALBI, EZ-ALBI, and PALBI, as well as their variations in predicting the recurrence of HCC following surgical procedures. Notably, the clinical characteristics of patients exhibiting varying levels of PALBI differed from those categorized under ALBI and EZ-ALBI; however, the ALBI grade shared similar characteristics with the EZ-ALBI category. A strong correlation was found between ALBI and EZ-ALBI, with a coefficient of 0.862 (95% CI: 0.838-0.882, p < 0.01), whereas ALBI and PALBI yielded a coefficient of 0.760 (95% CI: 0.838-0.882, p < 0.01). The correlation coefficient between PALBI and EZ-ALBI was recorded at 0.571 (95% CI: 0.510-0.626, p < 0.01). There was a notable difference in survival outcomes among HCC patients classified with ALBI/EZ-ALBI/PALBI grade 1 compared to those with grade 2 or 3. Additionally, Cox regression analysis identified that maximum tumor diameter (MTD), microvascular invasion (MVI), pathological grade, as well as ALBI/EZ-ALBI/PALBI grades, among other factors, were tied to a decline in progression-free survival (PFS). The area under the curve (AUC) for the ALBI model at the 1, 2, and 3-year postoperative mark was 0.705, 0.652, and 0.694, respectively. In parallel, the AUC of the EZ-ALBI model during the same time intervals was 0.708, 0.659, and 0.694, respectively. For PALBI, the AUC values recorded at 1, 2, and 3 years following surgery were 0.748, 0.707, and 0.725, respectively. ALBI, EZ-ALBI, and PALBI served as predictive indicators for the recurrence of HCC in patients after surgery. Compared to ALBI, EZ-ALBI offers greater convenience in forecasting the prognosis of HCC patients, whereas PALBI demonstrates more accuracy than ALBI in predicting their prognosis.

High tumor burden score indicated the unfavorable prognosis in patients with hepatocellular carcinoma: A meta-analysis

BACKGROUND

Tumor burden score (TBS) based on maximum tumor diameter and number has been shown to correlate with prognosis in patients with hepatocellular carcinoma (HCC). Nevertheless, the results are conflicting. Hence, we conducted a meta-analysis to analyze the association between TBS and survival outcomes of HCC patients.

METHODS

A comprehensively search of the databases including PubMed, Embase and Web of Science was performed to retrieve studies satisfying the inclusion criteria until August 31, 2023. The hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. All the data analyses were carried out by STATA 12.0.

RESULTS

10 retrospective studies containing 25073 patients were incorporated in the study. The results demonstrated that high TBS was markedly association with poor overall survival (OS) (HR: 1.79, 95% CI: 1.45-2.23) and relapse-free survival / progression-free survival(RFS/PFS) (HR: 1.71; 95% CI: 1.42-2.07). Subgroup analysis showed that the prognostic value of TBS in HCC was not affected by any subgroup.

CONCLUSIONS

TBS may be an efficient prognostic index in HCC patients.

Assessment of Albumin-Incorporating Scores at Hepatocellular Carcinoma Diagnosis Using Machine Learning Techniques: An Evaluation of Prognostic Relevance

Hepatocellular carcinoma (HCC) presents high mortality rates worldwide, with limited evidence on prognostic factors at diagnosis. This study evaluates the utility of common scores incorporating albumin as predictors of mortality at HCC diagnosis using Machine Learning techniques. They are also compared to other scores and variables commonly used. A retrospective cohort study was conducted with 191 patients from Virgen de la Luz Hospital of Cuenca and University Hospital of Guadalajara. Demographic, analytical, and tumor-specific variables were included. Various Machine Learning algorithms were implemented, with eXtreme Gradient Boosting (XGB) as the reference method. In the predictive model developed, the Barcelona Clinic Liver Cancer score was the best predictor of mortality, closely followed by the Platelet-Albumin-Bilirubin and Albumin-Bilirubin scores. Albumin levels alone also showed high relevance. Other scores, such as C-Reactive Protein/albumin and Child-Pugh performed less effectively. XGB proved to be the most accurate method across the metrics analyzed, outperforming other ML algorithms. In conclusion, the Barcelona Clinic Liver Cancer, Platelet-Albumin-Bilirubin and Albumin-Bilirubin scores are highly reliable for assessing survival at HCC diagnosis. The XGB-developed model proved to be the most reliable for this purpose compared to the other proposed methods.

Machine learning-based model for predicting tumor recurrence after interventional therapy in HBV-related hepatocellular carcinoma patients with low preoperative platelet-albumin-bilirubin score

Introduction

This study aimed to develop a prognostic nomogram for predicting the recurrence-free survival (RFS) of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients with low preoperative platelet-albumin-bilirubin (PALBI) scores after transarterial chemoembolization (TACE) combined with local ablation treatment.

Methods

We gathered clinical data from 632 HBV-related HCC patients who received the combination treatment at Beijing You'an Hospital, affiliated with Capital Medical University, from January 2014 to January 2020. The patients were divided into two groups based on their PALBI scores: low PALBI group (n=247) and high PALBI group (n=385). The low PALBI group was then divided into two cohorts: training cohort (n=172) and validation cohort (n=75). We utilized eXtreme Gradient Boosting (XGBoost), random survival forest (RSF), and multivariate Cox analysis to pinpoint the risk factors for RFS. Then, we developed a nomogram based on the screened factors and assessed its risk stratification capabilities and predictive performance.

Results

The study finally identified age, aspartate aminotransferase (AST), and prothrombin time activity (PTA) as key predictors. The three variables were included to develop the nomogram for predicting the 1-, 3-, and 5-year RFS of HCC patients. We confirmed the nomogram's ability to effectively discern high and low risk patients, as evidenced by Kaplan-Meier curves. We further corroborated the excellent discrimination, consistency, and clinical utility of the nomogram through assessments using the C-index, area under the curve (AUC), calibration curve, and decision curve analysis (DCA).

Conclusion

Our study successfully constructed a robust nomogram, effectively predicting 1-, 3-, and 5-year RFS for HBV-related HCC patients with low preoperative PALBI scores after TACE combined with local ablation therapy.

Albumin-bilirubin grade as a predictor of survival in hepatocellular carcinoma patients with thrombocytopenia

BACKGROUND

The models for assessing liver function, mainly the Child-Pugh (CP), albuminbilirubin (ALBI), and platelet-ALBI (PALBI) classifications, have been validated for use in estimating the prognosis of hepatocellular carcinoma (HCC) patients. However, thrombocytopenia is a common finding and may influence the prognostic value of the three models in HCC.

AIM

To investigate and compare the prognostic performance of the above three models in thrombocytopenic HCC patients.

METHODS

A total of 135 patients with thrombocytopenic HCC who underwent radical surgery were retrospectively analyzed. Preoperative scores on the CP, ALBI and PALBI classifications were estimated accordingly. Kaplan-Meier curves with log-rank tests and Cox regression models were used to explore the significant factors associated with overall survival (OS) and recurrence-free survival (RFS).

RESULTS

The preoperative platelet counts were significantly different among the CP, ALBI and PALBI groups. After a median follow-up of 28 mo, 39.3% (53/135) of the patients experienced postoperative recurrence, and 36.3% (49/135) died. Univariate analysis suggested that α-fetoprotein levels, tumor size, vascular invasion, and ALBI grade were significant predictors of OS and RFS. According to the multivariate Cox regression model, ALBI was identified as an independent prognostic factor. However, CP and PALBI grades were not statistically significant prognostic indicators.

CONCLUSION

The ALBI grade, rather than CP or PALBI grade, is a significant prognostic indicator for thrombocytopenic HCC patients.

Albumin-Based Liver Reserve Models vs. MELD 3.0 in Prognostic Prediction for Hepatocellular Carcinoma Patients with Renal Insufficiency

The severity of liver functional reserve is an important prognostic predictor in hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI), easy (EZ)-ALBI, platelet-albumin-bilirubin (PALBI), platelet-albumin (PAL) score, and MELD 3.0 score are used to evaluate the severity of liver dysfunction. However, their prognostic role in HCC patients, specifically with renal insufficiency (RI), is unclear. We aimed to investigate the predictive accuracy of the five models in these patients. A total of 1120 newly diagnosed HCC patients with RI were enrolled. A multivariate Cox proportional analysis was used to identify independent predictors associated with survival. In the Cox model, older age, an α-fetoprotein ≥20 ng/mL, vascular invasion, a medium and high tumor burden score, poor performance status, a higher ALBI grade, an EZ-ALBI grade, a PALBI grade, a PAL grade, and MELD 3.0 score were all independently associated with decreased overall survival (all p < 0.001). Among the five liver reserve models, the ALBI grade is the best surrogate marker to represent liver functional reserve in terms of outcome prediction. The albumin-based liver reserve models (ALBI, EZ-ALBI, PALBI, and PAL) and MELD 3.0 are all feasible prognostic markers to indicate liver injury, specifically in HCC patients with RI. Among them, the ALBI grade is the most robust tool for survival prediction in these patients.

Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review

This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.