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Novel Albumin–Bilirubin Grade-Based Risk Prediction Model for Patients with Hepatocellular Carcinoma Undergoing Chemoembolization

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Abstract

Background

Recently, albumin–bilirubin (ALBI) grade has been suggested as a better surrogate for hepatic functional reserve for patients with hepatocellular carcinoma (HCC).

Aims

We developed and validated a novel prediction model to predict outcome for HCC patients who underwent transcatheter arterial chemoembolization (TACE) as a first-line therapy.

Methods

From a multivariate Cox regression model for overall survival, five objective variables (ALBI grade), the Barcelona clinic liver cancer (BCLC) stage, response after the first TACE session, Alpha-fetoprotein level, and sex were chosen and the ABRAS score was developed from the derivation cohort (n = 476) and scored to generate an 8-point risk prediction model. The model’s prognostic performance was assessed in the randomly assigned internal validation set (n = 475) and external validation set (n = 243).

Results

The ALBI grade was able to stratify patient survival within the same Child–Pugh class. The time-dependent area under receiver operating characteristics curves (AUROCs) for overall survival at 1 and 3 years were 0.78 and 0.73 in the training set, 0.78 and 0.71 in the internal validation set, and 0.70 and 0.65 in the external validation set, respectively. When stratified by BCLC stage, ABRAS score at a cutoff point of more than 3, 4, and 5 for BCLC stage 0/A, B, and C could identify subset of patients with dismal prognosis.

Conclusion

ABRAS score was useful in estimating prognosis for patients who underwent TACE as a first-line therapy. This score can be useful in planning and guiding treatment strategies with TACE, which warrants prospective validation.

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Abbreviations

ALBI:

Albumin–bilirubin

HCC:

Hepatocellular carcinoma

TACE:

Transcatheter arterial chemoembolization

BCLC:

Barcelona clinic liver cancer

AUROC:

Area under receiver operating characteristics curves

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

AFP:

Alpha-fetoprotein

PIVKA-II:

Protein induced by vitamin K antagonist

mRECIST:

Modified response evaluation criteria in solid tumors

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

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Author’s contribution

Sinn DH and Choi MS contributed to the study design and supervision; Sinn DH and Kim JH were involved in the statistical analysis; Sinn DH, Lee JH, Kim JH, and Hyun D contributed to the writing of the draft manuscript; Kim JH, Lee JH, Cho SK, Shin SW, Chang Y, Kim JY, Yoon JH, Kang W, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, and Paik SW collected the data; Lee JH, Chang Y, Kim JY, Yoon JH, Kang W, Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC, Paik SW, and Choi MS were involved in the critical revision of the manuscript. All authors approved the final version of the manuscript.

Funding

This paper was supported by Research and Business foundation of Sungkyunkwan University (Grant number: S-2015-0047-000).

Author information

Author notes

  1. Jung Hee Kim, Dong Hyun Sinn and Jeong-Hoon Lee have contributed equally to this study.

Authors and Affiliations

  1. Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital of Hallym University Medical Center, Chuncheon, Korea

    Jung Hee Kim

  2. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea

    Dong Hyun Sinn, Wonseok Kang, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik & Moon Seok Choi

  3. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Jeong-Hoon Lee, Young Chang, Yoon Jun Kim & Jung-Hwan Yoon

  4. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Dongho Hyun, Sung Ki Cho & Sung Wook Shin

Authors
  1. Jung Hee Kim
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  2. Dong Hyun Sinn
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Corresponding author

Correspondence to Moon Seok Choi.

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The authors declare that they have no conflict of interest.

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Kim, J.H., Sinn, D.H., Lee, JH. et al. Novel Albumin–Bilirubin Grade-Based Risk Prediction Model for Patients with Hepatocellular Carcinoma Undergoing Chemoembolization. Dig Dis Sci 63, 1062–1071 (2018). https://doi.org/10.1007/s10620-018-4934-6

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  • DOI: https://doi.org/10.1007/s10620-018-4934-6

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