Comparison of albumin-bilirubin grade, platelet-albumin-bilirubin grade and Child-Turcotte-Pugh class for prediction of survival in patients with large hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation

Figures & data

Table 1. Baseline patient characteristics stratified by ALBI grade.

Characteristic	ALL	ALBI grade 1	ALBI grade 2	ALBI grade 3	p Value
	(n = 349)	(n = 86)	(n = 182)	(n = 81)
Age (year)*	53.4 ± 12.27	51.5 ± 12.10	54.5 ± 11.57	54.2 ± 12.99	.051
Gender					.801
Male	311 (89.1)	75 (87.2)	163 (89.6)	73 (90.1)
Female	38 (10.9)	11 (12.8)	19 (10.4)	8 (9.9)
ECOG (score)					<.001
0	90 (25.8)	37 (43.0)	45 (24.7)	8 (9.9)
1	259 (74.2)	49 (57.0)	137 (75.3)	73 (90.1)
Etiology					.637
HBV/HCV	273 (78.2)	70 (81.4)	139 (76.4)	64 (79.0)
None	76 (21.8)	16 (18.6)	43 (23.6)	17 (21.0)
Hepatic cirrhosis					.664
With	156 (44.7)	38 (44.2)	85 (46.7)	33 (40.7)
Without	193 (55.3)	48 (55.8)	97 (53.3)	48 (59.3)
Tumor size (cm)^†	7.9 (5.1–8.0)	7.5 (5.2–8.0)	8.4 (5.1–8.0)	7.3 (6.1–7.9)	.960
Tumor number					.069
Single	190 (54.4)	61 (70.9)	95 (52.2)	34 (42.0)
Multiple	159 (45.6)	25 (29.1)	87 (47.8)	47 (58.0)
Albumin level (g/dL)^†	37.8 (24.9–49.2)	43.0 (25.3–49.2)	36.5 (26.0–44.5)	33.0 (24.9–48.9)	<.001
TBIL level (mg/dL)^†	18.3 (5.4–136.0)	14.1 (5.4–46.1)	19.4 (9.6–65.6)	25.4 (7.3–136.0)	<.001
AST level (U/L)^†	46.2 (9.9–845.0)	35.0 (9.9–143.0)	48.4 (15.0–828.4)	53.2 (15.4–845.0)	.003
ALT level (U/L)^†	41.0 (7.2–691.4)	37.0 (9.0–264.0)	42.0 (8.3–691.4)	43.5 (7.2–655.0)	.056
Prothrombin time INR^†	1.06 (0.81–2.55)	1.03 (0.87–1.31)	1.09 (0.86–2.55)	1.07 (0.81–1.51)	.075
a-fetoprotein level (ng/mL)^†	141.0 (0.29–129470.0)	82.6 (1.19–121000.0)	117.3 (0.29–129470.0)	538.9 (1.60–121000.0)	.139
Platelet count (×10^9/L)^†	150.0 (50.0–478.0)	162.0 (56.0–392.0)	145.0 (50.0–468.0)	147.0 (51.0–478.0)	.863
CTP class					<.001
A	261 (74.8)	85 (98.8)	142 (78.0)	34 (42.0)
B	88 (25.2)	1 (1.2)	40 (22.0)	47 (58.0)
TACE session					.274
≤3	220 (63.0)	57 (66.3)	118 (64.8)	45 (55.6)
>3	129 (37.0)	29 (33.7)	64 (35.2)	36 (44.4)
MWA session					.496
≤3	278 (79.7)	66 (76.7)	144 (79.1)	68 (84.0)
>3	71 (20.3)	20 (23.3)	38 (20.9)	13 (16.0)

Unless otherwise indicated data are number of patients, with percentage in parentheses.

* Data are means ± standard deviation.

† Data are medians, with interquartile range in parentheses.

ALBI: albumin-bilirubin; ECOG: Eastern Cooperative Oncology Group; HBV: hepatitis B virus; HCV: hepatitis C virus; TBIL: total bilirubin;

AST: aspartate aminotransferase; ALT: alanine aminotransferase; cm: centimeter; INR: international normalized ratio;

BCLC: Barcelona Clinic Liver Cancer; CTP: Child-Turcotte-Pugh; TACE: transarterial chemoembolization; MWA: microwave ablation.

Figure 1. Kaplan-Meier curves of overall survival in all 349 patients with large HCCs after TACE-MWA.

Figure 2. Kaplan-Meier curves of progression-free survival (A) and the progression-free survival stratified by the ablation margin size (B) in all 349 patients with large HCCs after TACE-MWA.

Table 2. Univariable and multivariable predictors of overall survival.

Factor		Univariate analysis		Multivariate analysis
	No. of Pts (n = 349)	Hazard ratio	p Value	ALBI grade		PALBI grade		CTP class
				Hazard ratio	p Value	Hazard ratio	p Value	Hazard ratio	p Value
Age (year)		0.95 (0.73–1.24)	.717
<60	234
≥60	115
Gender		0.85 (0.56–1.29)	.451
Male	311
Female	38
ECOG (score)		2.89 (2.09–4.00)	<.001	2.06 (1.44–2.95)	<.001	2.09 (1.45–3.02)	<.001	2.12 (1.47–3.04)	<.001
0	90
1	259
Etiology		1.22 (0.95–1.56)	.120
HBV/HCV	273
None	76
Hepatic cirrhosis		0.82 (0.64–1.05)	.120
With	156
Without	193
Tumor number		1.82 (1.42–2.33)	<.001	1.24 (0.94–1.63)	.123	1.21 (0.92–1.59)	.170	1.24 (0.94–1.62)	.131
Single	190
Multiple	159
Albumin level		0.45 (0.34–0.59)	<.001	0.87 (0.64–1.17)	.339	0.71 (0.53–0.96)	.240	0.80 (0.57–1.13)	.202
≤3.5 g/dL	112
>3.5 g/dL	237
TBIL level		1.62 (1.26–2.08)	<.001	0.99 (0.75–1.31)	.956	0.89 (0.64–1.22)	.454	1.16 (0.89–1.53)	.276
≤1.0 mg/dL	174
>1.0 mg/dL	175
ALT level		1.19 (0.93–1.52)	.178
≤40 U/L	172
>40 U/L	177
PT INR		1.07 (0.79–1.44)	.663
≤1.0	83
>1.0	266
AFP level		1.76 (1.37–2.26)	<.001	1.39 (1.08–1.79)	.011	1.38 (1.07–1.78)	.015	1.64 (1.27–2.12)	<.001
≤400 ng/mL	208
>400 ng/mL	141
Platelet count		0.91 (0.68–1.20)	.487
≤100 × 10^9 /L	85
>100 × 10^9 /L	264
CTP class		2.99 (2.27–3.96)	<.001					2.16 (1.49–3.15)	<.001
A	261
B	88
ALBI grade
1	86	1		1
2	182	0.13 (0.09–0.19)	<.001	0.18 (0.11–0.29)	<.001
3	81	0.35 (0.26–0.47)	<.001	0.41 (0.29–0.57)	<.001
PALBI grade
1	135	1				1
2	106	0.26 (0.19–0.36)	<.001			0.35 (0.23–0.53)	<.001
3	108	0.38 (0.28–0.52)	<.001			0.46 (0.32–0.67)	<.001
TACE session		1.21 (0.94–1.56)	.149
≤3	220
>3	129
MWA session		0.83 (0.61–1.13)	.243
≤3	278
>3	71
Ablation margin size		0.98 (0.73–1.20)	.029	0.88 (0.63–1.25)	.273	0.75 (0.51–1.13)	.125	1.12 (0.76–1.65)	.419
0–5 mm	90
6–10 mm	119
11–15mm	140

Data in parentheses are 95% confidence intervals.

Pts: patients; ECOG: Eastern Cooperative Oncology Group; HBV: hepatitis B virus; HCV: hepatitis C virus; cm: centimeter;

TBIL: total bilirubin; ALT: alanine aminotransferase; PT INR: prothrombin time international normalized ratio;

ALBI: albumin-bilirubin; PALBI: platelet-albumin-bilirubin; CTP: Child-Turcotte-Pugh; AFP: a-fetoprotein;

TACE: transarterial chemoembolization; MWA: microwave ablation; mm: millimeter.

Table 3. Univariable and multivariable predictors of progression-free survival.

Factor		Univariate analysis		Multivariate analysis
	No. of Pts (n = 349)	Hazard ratio	p Value	ALBI grade		PALBI grade		CTP class
				Hazard ratio	p Value	Hazard ratio	p Value	Hazard ratio	p Value
Age (year)		1.21 (0.97–1.50)	.085	1.19 (0.96–1.49)	.119	2.20 (2.07–2.60)	.351	1.47 (1.05–1.77)	.209
<60	234
≥60	115
Gender		0.99 (0.69–1.42)	.978
Male	311
Female	38
ECOG (score)		1.75 (1.38–2.23)	<.001	0.76 (0.58–1.00)	.047	1.09 (0.45–2.02)	<.001	3.62 (2.97–4.54)	<.001
0	90
1	259
Etiology		1.18 (0.90–1.55)	.225
HBV/HCV	273
None	76
Hepatic cirrhosis		0.90 (0.73–1.12)	.353
With	156
Without	193
Tumor number		0.47 (0.35–0.63)	<.001	0.41 (0.21–0.71)	.006	0.21 (0.12–0.52)	.001	0.64 (0.34–1.02)	.021
Single	190
Multiple	159
Albumin level		0.64 (0.52–0.79)	<.001	1.02 (0.78–1.34)	.872	1.71 (1.54–1.99)	.140	1.87 (1.64–2.13)	.289
≤3.5 g/dL	112
>3.5 g/dL	237
TBIL level		1.31 (1.05–1.63)	.017	0.85 (0.66–1.09)	.194	1.91 (1.74–2.62)	.306	1.18 (0.91–1.55)	.517
≤1.0 mg/dL	174
>1.0 mg/dL	175
ALT level		1.07 (0.87–1.33)	.526
≤40 U/L	172
>40 U/L	177
PT INR		0.88 (0.67–1.16)	.354
≤1.0	83
>1.0	266
AFP level		1.21 (0.97–1.49)	.088	0.88 (0.71–1.09)	.266	0.78 (0.37–1.28)	.315	0.64 (0.27–1.12)	.719
≤400 ng/mL	208
>400 ng/mL	141
Platelet count		1.13 (0.90–1.40)	.294
≤100 × 10^9 /L	85
>100 × 10^9 /L	264
CTP class		1.89 (1.50–2.37)	<.001					0.46 (0.29–0.71)	.201
A	261
B	88
ALBI grade
1	86	1		1
2	182	0.21 (0.14–0.31)	<.001	0.30 (0.19–0.47)	<.001
3	81	0.46 (0.35–0.58)	<.001	0.57 (0.43–0.78)	<.001
PALBI grade
1	135	1				1
2	106	0.56 (0.49–0.66)	<.001			0.24 (0.42–0.71)	<.001
3	108	0.68 (0.58–0.82)	<.001			0.61 (0.47–0.82)	<.001
TACE session		0.58 (0.43–0.79)	.001
≤3	220
>3	129
MWA session		0.67 (0.54–0.84)	.001
≤3	278
>3	71
Ablation margin size		0.38 (0.13–0.60)	<.001	0.56 (0.31–0.85)	<.001	0.69 (0.44–0.98)	<.001	0.73 (0.49–1.02)	<.001
0–5 mm	90
6–10 mm	119
11–15mm	140

Data in parentheses are 95% confidence intervals.

Pts: patients; ECOG: Eastern Cooperative Oncology Group; HBV: hepatitis B virus; HCV: hepatitis C virus; cm: centimeter;

TBIL: total bilirubin; ALT: alanine aminotransferase; PT INR: prothrombin time international normalized ratio;

ALBI: albumin-bilirubin; PALBI: platelet-albumin-bilirubin; CTP: Child-Turcotte-Pugh; AFP: a-fetoprotein;

TACE: transarterial chemoembolization; MWA: microwave ablation.

Figure 3. Kaplan-Meier curves of overall survival in all 349 patients stratified by the ALBI grade (A), PALBI grade (B), and CTP class (C). ALBI: albumin-bilirubin; PALBI: platelet-albumin-bilirubin; CTP: Child-Turcotte-Pugh.

Figure 4. Kaplan-Meier curves of overall survival (A&C) and progression-free survival (B&D) in patients with the CTP class A (A&B) and CTP class B (C&D) stratified by the ALBI grade. ALBI: albumin-bilirubin; CTP: Child-Turcotte-Pugh.

Figure 5. Kaplan-Meier curves of overall survival (A&C) and progression-free survival (B&D) in patients with the CTP class A (A&B) and CTP class B (C&D) stratified by the PALBI grade. PALBI: platelet-albumin-bilirubin; CTP: Child-Turcotte-Pugh.

Table 4. Overall survival and progression-free survival stratified by ALBI grade, PALBI grade and CTP class.

	No. of Pts	Overall survival			Progression-free survival
Subgroup	(n = 349)	Median (month)	χ^2	p Value	Median (month)	χ^2	p Value
ALBI grade			114.9	<.001		64.1	<.001
1	86	69.0 (10.0–221.0)			17.0 (1.0–96.0)
2	182	29.0 (5.0–121.0)			4.5 (0.5–51.0)
3	81	11.0 (4.0–90.0)			2.5 (0.5–31.0)
PALBI grade			85.2	<.001		30.6	<.001
1	136	52.0 (5.0–221.0)			5.5 (0.5–96.0)
2	105	37.0 (5.0–84.0)			5.0 (0.5–49.0)
3	108	14.0 (5.0–78.0)			2.5 (0.5–36.0)
CTP class			67.3	<.001		33.1	<.001
A	261	40.0 (5.0–221.0)			5.0 (0.5–96.0)
B	88	13.0 (4.0–90.0)			3.0 (0.5–39.0)
CTP class A			102.8	<.001		44.1	<.001
ALBI grade 1	85	69.0 (10.0–221.0)			15.5 (1.0–96.0)
ALBI grade 2	142	35.0 (5.0–121.0)			5.5 (1.0–51.0)
ALBI grade 3	34	10.0 (5.0–75.0)			2.1 (0.5–31.0)
CTP class B			1.3	.246		12.4	.029
ALBI grade 2	41	13.0 (5.0–73.0)			3.0 (0.5–39.0)
ALBI grade 3	47	13.0 (4.0–90.0)			2.5 (0.5–26.0)
CTP class A			34.9	<.001		13.4	.001
PALBI grade 1	128	54.0 (9.0–221.0)			6.5 (1.0–96.0)
PALBI grade 2	87	40.0 (7.0–84.0)			6.0 (1.0–49.0)
PALBI grade 3	46	18.0 (5.0–78.0)			2.5 (0.5–56.0)
CTP class B			4.1	.132		1.27	.531
PALBI grade 1	8	18.0 (5.0–90.0)			3.0 (0.5–36.0)
PALBI grade 2	18	13.0 (5.0–73.0)			2.7 (0.5–25.0)
PALBI grade 3	62	12.0 (4.0–56.0)			2.5 (0.5–21.0)

Unless otherwise indicated data are medians, with interquartile range in parentheses.

ALBI: albumin-bilirubin; PALBI: platelet-albumin-bilirubin; CTP: Child-Turcotte-Pugh; Pts: patients.

Figure 6. Receiver operating characteristic curves and corresponding AUC for 1-(A), 3-(B) and 5-year (C) OS. ALBI: albumin-bilirubin; APLBI: platelet-albumin-bilirubin; CI: confidence interval; AUC: area under the curve.