A novel prognostic model based on AFP, tumor burden score and Albumin-Bilirubin grade for patients with hepatocellular carcinoma undergoing radiofrequency ablation

Figures & data

Figure 1. Patient inclusion flowchart.

Table 1. Baseline demographics and clinical characteristics in 716 patients.

Variable	Total cohort (n = 716) N or Mean (range)	Training cohort (n = 358) N or Median (range)	Validation cohort (n = 358) N or Median (range)	p-value
Gender, Male/Femal	606/110	296/62	310/48	0.147
Age (years), <55, ≥55	303/413	141/217	162/196	0.112
HBsAg, P/N	619/97	312/46	307/51	0.585
HCVAb, P/N	30/686	14/344	16/342	0.709
HBV DNA (IU/mL), <100, ≥100	465/251	237/121	228/130	0.481
ALB (IU/L)	39 (21.9–53.6)	39 (21.9–49)	39 (22–53.6)	0.877
ALT (IU/L)	30 (3.5–204)	29 (7–204)	31 (3.5-194)	0.390
AST (IU/L)	33 (12–272)	32 (12–272)	33 (13–247)	0.265
TBIL (IU/L)	15.1 (3.8–72.2)	14.8 (3.8–59.9)	15.3 (4.2–72.2)	0.573
AFP (ng/mL), <400, ≥400	614/102	306/52	308/50	0.831
PLT (×10^9/L), <150, ≥150	430/286	213/145	217/141	0.760
Tumor Size (cm), mean ± SD	2.49 ± 0.88	2.43 ± 0.87	2.56 ± 0.90	0.385
Tumor Size (cm), median (IQR)	2.3 (0.6–6.2)	2.3 (0.6–5.9)	2.4(1.0–6.2)	0.066
≤3cm	550	287	263
3.1–5.0cm	159	68	91
≥ 5.1cm	7	3	4
Tumor Number, 1/2/3	610/87/19	301/49/8	309/38/11	0.374
Child-pugh, A5-6/B7	680/36	342/16	338/20	0.494
ALBI grade, 1/2/3	331/376/9	167/187/4	164/189/5	0.928
TBS, low/medium/high	260/220/236	135/111/112	125/109/124	0.603
BCLC staging system, 0/1	219/497	115/243	104/254	0.372
CLIP score, 0/1/2	496/196/24	246/99/13	250/97/11	0.896
CUPI, 1/2	697/19	348/10	349/9	0.816
JIS score, 0/1/2	578/134/4	288/67/3	290/67/1	0.604
Okuda staging system, 1/2/3	665/49/2	332/26/0	333/23/2	0.452
PFS, median (IQR)	31 (1–153)	32 (1–144)	30 (1-153)	0.648
Overall Survival, median (IQR)	54 (1–153)	53 (1–150)	55 (6-153)	0.745

HBsAg: hepatitis B surface antigen; HCVAb: antibody to hepatitis C virus; HBV DNA: hepatitis B virus DNA; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TBIL: total bilirubin; AFP: ɑ-fetoprotein; PLT: platelets; TBS: tumor burden score; ALBI: albumin-bilirubin; AJCC: American joint committee on cancer; BCLC: Barcelona Clinic Liver Cancer; CLIP: the Cancer of the liver Italian program; CUPI: the Chinese university prognostic index; JIS: the Japan iIntegrated staging; PFS: Progression-free Survival; IQR: inter quartile range.

Table 2. Univariable and multivariable analyses of factors associated with progression-free survival and overall survival.

	OS				PFS
Variable	Univariate p-value	Univariate HR (95%CI)	Multivariate p-value	Multivariate HR (95%CI)	Univariate p-value	Univariate HR (95%CI)	Multivariate p-value	Multivariate HR (95%CI)
sex	0.467	0.567-1.297			0.411	0.615-1.220
Age ≥ 55	0.008	1.120–2.166			0.064	0.986–1.663
HBsAg (+)	0.342	0.506–1.266			0.302	0.822–1.881
HCVAb (+)	0.550	0.567–2.903			0.817	0.454–1.864
HBV DNA ≥100	0.114	0.534–1.069			0.478	0.694–1.187
ALT (IU/L)	0.322	0.998–1.007			0.586	0.997–1.005
AST (IU/L)	0.126	0.999–1.008			0.348	0.998–1.006
AFP (ng/mL), ≥400	<0.001	1.408–2.999	<0.001	1.525–3.284	<0.001	1.313–2.548	<0.001	1.383–2.698
PLT (×10^9/L), ≥150	0.030	0.511–0.965			0.091	0.61–1.037
ALBI
<–2.60	1				1
−2.60– −1.39	<0.001	1.456–2.764	<0.001	1.358–2.600	0.030	1.028–1.719	0.085
>–1.39	0.014	1.450–25.157	0.009	1.622–28.736	0.883	0.274–4.509	0.912
TBS
<2.42	1				1
2.42–3.07	0.015	1.107–2.550	0.026	1.059–2.474	0.020	1.062–2.013	0.010	1.106–2.102
>3.07	<0.001	1.954–4.259	<0.001	2.050–4.525	<0.001	1.755–3.255	<0.001	1.803–3.353

HBsAg: hepatitis B surface antigen; HCVAb: antibody to hepatitis C virus; HBV DNA: hepatitis B virus DNA; ALT: alanine aminotransferase; AST: aspartate aminotransferase; TBIL: total bilirubin; AFP: ɑ-fetoprotein; PLT: platelets; TBS: tumor burden score; ALBI: albumin-bilirubin.

Figure 2. Graphs Depict performance of the Cox proportional hazards model of the at and ATA scores. (A) From the 1,3,5-year progression-free survival aspect, the time-dependent AUC of the training set was 0.651,0.667, and 0.620, respectively. (B) while the AUC of the validation set was 0.657, 0.687, and 0.704, respectively. (C) From the 1,3,5-year overall survival aspect, the time-dependent AUC of the training set was 0.680,0.712, and 0.666, respectively. (D) while the AUC of the validation set was 0.712, 0.706, and 0.726, respectively.

Figure 3. Graphs Show comparison Kaplan–Meier curves of (A) progression-free survival (PFS) between low-risk (at score constructed from AFP and TBS [at score] < 7) and high-risk (at score ≥7) patients; (B)overall survival (OS) between low-risk (ATA score constructed from AFP, TBS, and ALBI [ATA score] < 5) and high-risk (ATA score ≥5) patients.

Table 3. Prognostic performance of different staging systems in the validation cohort.

Models for PFS	C-index (95% CI)	AIC	Models for OS	C-index (95% CI)	AIC
AT	0.643 (0.606–0.680)	2508.747	ATA	0.693 (0.650–0.736)	1805.383
BCLC	0.567 (0.536–0.598)	2544.844	BCLC	0.578 (0.545–0.611)	1860.631
CLIP	0.579 (0.548–0.610)	2541.083	CLIP	0.587 (0.548–0.626)	1858.075
CUPI	0.514 (0.502–0.526)	2569.156	CUPI	0.524 (0.508–0.540)	1863.978
JIS	0.53 (0.505–0.555)	2560.309	JIS	0.534 (0.501–0.567)	1873.307
Okuda	0.524 (0.506–0.542)	2562.536	Okuda	0.526 (0.504–0.548)	1869.451

AT: ɑ-fetoprotein and tumor burden score; ATA: ɑ-fetoprotein, tumor burden score and albumin-bilirubin score; BCLC: Barcelona Clinic Liver Cancer; CLIP: the Cancer of the liver Italian program; CUPI: the Chinese university prognostic index; JIS: the Japan Integrated staging.