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Prognosticating Survival in Hepatocellular Carcinoma with Elevated Baseline Alpha-fetoprotein Treated with Radioembolization Using a Novel Laboratory Scoring System: Initial Development and Validation



To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with radioembolization and develop/validate a scoring system.


With IRB approval, we included all patients with baseline alpha-fetoprotein (AFP) > 100 ng/dL from our prospectively acquired HCC radioembolization database. Neutrophil–lymphocyte ratio, albumin–bilirubin (ALBI), and AFP were measured at baseline and at 1-, 3-, and 6-month post-radioembolization Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Baseline Imaging, Laboratory, and Combination scoring systems were developed. Developing/validating groups were created to investigate/validate the score’s OS predictability. Time-dependent receiver operating characteristics (ROC) were evaluated. Patients were stratified into groups I, II, and III by using 25th and 75th percentile cutoffs according to change in Laboratory Score from baseline.


345/401 (86%), 238/401 (59%), and 167/401 (42%) patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI and AFP were significant OS prognosticators at all Landmarks. The Laboratory Score [ALBI + (0.3 × LnAFP)] was developed/internally validated to predict OS from these Landmarks. Areas under the curve of time-dependent ROCs of the Baseline Imaging vs. Laboratory scores in predicting patient OS post 3 and 6 months Landmarks were 0.56 versus 0.82 and 0.57 versus 0.77, respectively. OS differences in groups I, II, and III according to change in Laboratory Score from baseline were significant (p < 0.001).


Post-radioembolization AFP and ALBI scores were significant OS prognosticators. A decrease in post-therapeutic Laboratory Score, which combines AFP and ALBI, correlates with an improved OS.

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Change history

  • 06 February 2020

    The name of the eleventh author is listed incorrectly in the published article as Nitin Kataraya. The correct name is Nitin Katariya.


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Rehan Ali and Yihe Yang are co-first authors for this manuscript. Rehan Ali, Yihe Yang, Ahmed Gabr, Laura Kulik, Mary Mulcahy, Al Benson, Robert Lewandowski, Riad Salem, Ahsun Riaz helped in study concept and design. Rehan Ali, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi were involved in acquisition of data. Rehan Ali, Yihe Yang, Ahmed Gabr, Nadine Abouchaleh, Ali Al Asadi, Ronald A. Mora, Daniel Ganger, Laura Kulik, Michael Abecassis, Mary Mulcahy, Robert Lewandowski, Riad Salem, Ahsun Riaz contributed to the analysis and interpretation of data. Rehan Ali, Yihe Yang Nadine Abouchaleh, Ali Al Asadi, Ronald A. Mora, Robert Lewandowski, Riad Salem, Ahsun Riaz drafted the manuscript. All Authors were involved in the critical revision of the manuscript for important intellectual content. Rehan Ali, Yihe Yang, Mark Antkowiak, Ahmed Gabr, Nadine Abouchaleh helped in statistical analysis. All Authors contributed to the administrative, technical, or material support. Robert Lewandowski, Riad Salem, Ahsun Riaz helped in study supervision.

Correspondence to Ahsun Riaz.

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RS, RJL and LK are advisors to BTG. None of the other co-authors report any conflict of interest.

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Ali, R., Yang, Y., Antkowiak, M. et al. Prognosticating Survival in Hepatocellular Carcinoma with Elevated Baseline Alpha-fetoprotein Treated with Radioembolization Using a Novel Laboratory Scoring System: Initial Development and Validation. Cardiovasc Intervent Radiol 42, 700–711 (2019).

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  • Hepatocellular carcinoma (HCC)
  • Alpha-fetoprotein (AFP)
  • TARE
  • Radioembolization
  • HCC survival
  • Laboratory prognosticators for HCC survival