Albumin-Bilirubin and Platelet-Albumin-Bilirubin Grades Accurately Predict Overall Survival in High-Risk Patients Undergoing Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma

Purpose: To evaluate albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades in predicting overall survival in high risk patient Undergoing conventional transarterial chemoembolization for hepatocellular carcinoma (BCC). Materials and Methods: This single-center retrospective study included 180 high-risk patients (142 men, 59 +/- 9) between April 2007 and January 2015. Patients were considered high-risk based on laboratory abnormalities before the Procedure (bilirubin > 2.0 mg/dL, albumin < 3.5 mg/dL, platelet count < 60,000/mL, creatinine > 1.2 mg/dL); presence of ascites, encephalopathy, portal vein thrombus, or transjugular intrahepatic portosystemic shunt; or Model for End-Stage Liver Disease score > 15. Serum albumin, bilirubin, and platelet values were used to determine ALBI and PALBI grades. Overall survival was stratified by ALBI and PALBI grades with substratification by Child-Pugh class (CPC) and BarCelona Liver Clinic Cancer (BCLC) stage using Kaplan-Meier analysis. C-index was used to determine discriminatory ability and survival prediction accuracy. Results: Median, survival for 79 ALBI grade 2 patients and 101 ALBI grade 3 patients was 20.3 and 10.7 months, respectively (P < .0001.). Median survival for 30 PALBI grade 2 and 144 PALBI grade 3 patients was 20.3 and 12:9 months, respectively (P = .0667). Substratification yielded distinct ALBI grade survival curves fot CPC B:(P = .0022, C-index 0.892), BCLC A (P = .0308, C-index 0.887), and BCLC C (P = .0287, C-index 0.839). PALBI grade demonstrated distinct survival curves for BCLC A (P = 0.0229, C-index 0.869): CPC yielded distinct survival curves for the entire cohort (P = .0019) but not when substratified by BCLC stage (all P > .05). Conclusions: ALBI and PALBI grades are accurate survival metrics in high-risk patients undergoing conventional transarterial chernoembolization for HCC. Use of these scores allows for more refined survival stratification within CPC and BCLC stage.