The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count

Figures & data

Table 1 Basic Characteristics of HCC Patients Stratified According to Levels of the PALBI

Variables	Overall	PALBI Grade
		1 (n=264)	2/3 (n=201)	P value
Etiology: HBV/others	418/47	234/30	184/17	0.303
Sex: male/female	366/99	204/60	162/39	0.386
Age (years)	52.9±10.7	53.1±10.4	52.6±11.2	0.614
Age: >60/≤60 years	344/121	198/66	146/55	0.565
ALT (U/L)	34.4(23.0–59.8)	29.0(20.0–44.0)	46.0(26.9–88.0)	<0.001
AST (U/L)	37.0(26.0–55.0)	32.5(24.0–44.0)	43.9(28.0–82.9)	<0.001
TBIL (µmol/L)	13.4(10.2–18.7)	11.4(9.0–14.3)	18.2(13.4–24.9)	<0.001
ALB (g/L)	39.6(35.6–42.8)	41.9(39.0–45.0)	36.2(33.2–39.6)	<0.001
PLT (10^9/L)	137(100–197)	129(97–175)	152(110–225)	<0.001
AFP (ng/mL)	62.4(5.1–1051.1)	104.4(6.3–1210.0)	38.7(4.7–847.9)	0.245
AFP: ≥400/<400ng/ml	151/314	87/177	64/137	0.799
Ascites: yes/no	65/400	28/236	37/164	0.016
Tumor size (cm)	5.0(3.5–8.0)	5.0(3.5–7.5)	6.0(3.5–9.0)	0.023
Tumor size: >5/≤5cm	223/242	118/146	105/96	0.107
Tumor number: multiple/single	66/399	38/226	28/173	0.887
Vascular invasion: yes/no	61/404	32/232	29/172	0.465
Cirrhosis: yes/no	229/236	142/122	87/114	0.025
BCLC: 0+A/B+C	341/124	198/66	143/58	0.352
CLIP: 0/1-4	237/228	141/123	96/105	0.227
C-P grade: A/B	407/58	257/7	150/51	<0.001
ALBI score	−2.64(−2.93 to −2.24)	−2.84(−3.11 to −2.63)	−2.24(−2.52 to −1.96)	<0.001
ALBI grade (1/2)	254/211	209/55	45/156	<0.001

Notes: Data were expressed as median (interquartile range), mean value ± SD, or no. Bold font highlights significant results.

Abbreviations: PALBI, platelet–albumin–bilirubin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBIL, total bilirubin; ALB, albumin; PLT, platelet count; AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CLIP, Cancer of the Liver Italian Program; C-P, Child–Pugh; ALBI, albumin–bilirubin.

Figure 1 Kaplan–Meier cumulative overall survival (A) and recurrence-free survival (B) curves of the study population, and overall survival and recurrence-free survival curves of patients stratified according to BCLC (C–D) and CLIP (E–F) staging systems.

Table 2 Univariate Analysis of Factors Associated with Overall Survival and Recurrence-Free Survival of HCC Patients

Variables	OS		RFS
	HR(95% CI)	P value	HR(95% CI)	P value
Etiology (HBV/others)	0.726(0.436–1.206)	0.218	0.816(0.518–1.288)	0.383
Sex (male/female)	0.940(0.637–1.387)	0.755	0.942(0.659–1.345)	0.742
Age (>60/≤60 years)	1.304(0.919–1.850)	0.137	1.350(0.988–1.845)	0.059
ALT (>40/≤40 U/L)	1.256(0.908–1.737)	0.168	1.359(1.018–1.814)	0.038
AST (>40/≤40U/L)	1.841(1.327–2.555)	<0.001	1.832(1.370–2.449)	<0.001
TBIL (>17/≤17µmol/L)	1.412(1.011–1.972)	0.043	1.368(1.015–1.845)	0.040
ALB (<35/≥35g/L)	1.472(1.031–2.102)	0.034	1.332(0.959–1.849)	0.087
PLT (<100/100–300×10^9/L)	1.472(1.034–2.096)	0.032	1.454(1.059–1.996)	0.021
PLT (>100/100–300×10^9/L)	2.212(1.225–3.994)	0.008	2.181(1.303–3.652)	0.003
AFP (≥400/<400ng/mL)	1.689(1.218–2.342)	0.002	1.846(1.379–2.470)	<0.001
Ascites (yes/no)	1.142(0.743–1.757)	0.545	1.197(0.817–1.752)	0.356
Tumor size (>5/≤5cm)	3.013(2.112–4.300)	<0.001	2.820(2.075–3.833)	<0.001
Tumor number (multiple/single)	1.312(0.877–1.962)	0.186	1.315(0.910–1.901)	0.145
Vascular invasion (yes/no)	2.167(1.457–3.224)	<0.001	1.959(1.350–2.845)	<0.001
Cirrhosis (yes/no)	0.976(0.698–1.365)	0.888	1.020(0.762–1.365)	0.894
BCLC (B+C/A)	1.920(1.379–2.674)	<0.001	1.773(1.314–2.394)	<0.001
CLIP (1–4/0)	1.333(1.179–1.507)	<0.001	1.989(1.479–2.675)	<0.001
C-P grade (B/A)	1.876(1.249–2.818)	0.002	1.618(1.105–2.370)	0.013
ALBI grade (2/1)	1.948(1.400–2.710)	<0.001	1.584(1.187–2.116)	0.002
PALBI grade (2–3/1)	2.074(1.493–2.879)	<0.001	1.684(1.261–2.250)	<0.001

Note: Bold font highlights significant results.

Abbreviations: OS, overall survival; RFS, recurrence-free survival; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBIL, total bilirubin; ALB, albumin; PLT, platelet count; AFP, alpha-fetoprotein; BCLC, Barcelona Clinic Liver Cancer; CLIP, Cancer of the Liver Italian Program; C-P, Child–Pugh; ALBI, albumin–bilirubin; PALBI, platelet–albumin–bilirubin.

Figure 2 Kaplan–Meier cumulative overall survival and recurrence-free survival curves of patients stratified according to ALBI (A–B) and PALBI (C–D).

Figure 3 Forest plots based the results of multivariate analysis for overall survival (A) and recurrence-free survival (B).

Figure 4 Kaplan–Meier cumulative overall survival and recurrence-free survival curves of patients stratified according to PLT (A–D), PALBI in patients with thrombocytopenia (E–F), and PALBI in patients excluding thrombocytopenia (G–H).

Table 3 Ranking of Discriminatory Ability of the Prognostic Systems on the Basis of the C-Index in All Patients

Rank	System	C-Index	95% CI
1	BCLC stage	0.651	0.599–0.704
2	CLIP stage	0.643	0.588–0.698
3	ALBI score	0.640	0.585–0.694
4	PALBI score	0.631	0.576–0.686
5	C-P score	0.585	0.529–0.642

Abbreviations: BCLC, Barcelona Clinic Liver Cancer; CLIP, Cancer of the Liver Italian Program; ALBI, albumin–bilirubin; PALBI, platelet–albumin–bilirubin; C-P, Child–Pugh.

Table 4 Ranking of Discriminatory Ability of the Prognostic Systems on the Basis of the C-Index in HCC Patients Excluding Thrombocytopenia

Rank	System	C-Index	95% CI
1	PALBI + tumor size	0.730	0.674–0.786
2	ALBI + tumor size	0.718	0.660–0.776
3	C-P + tumor size	0.701	0.642–0.761
4	PALBI score	0.655	0.590–0.720
5	BCLC stage	0.648	0.585–0.711
6	ALBI score	0.647	0.581–0.712
7	CLIP stage	0.645	0.578–0.712
8	C-P score	0.578	0.510–0.647

Abbreviations: PALBI, platelet–albumin–bilirubin; ALBI, albumin–bilirubin; C-P, Child–Pugh; BCLC, Barcelona Clinic Liver Cancer; CLIP, Cancer of the Liver Italian Program.

Figure 5 Cumulative overall survival and recurrence-free survival curves of patients stratified according to PALBI and tumor size (A–B, Stage I PALBI grade 1 and tumor size ≤5 cm; Stage II: PALBI grade 1 and tumor size >5 cm, or PALBI grade 2–3 and tumor size ≤5 cm; Stage III: PALBI grade 2–3 and tumor size >5 cm) in HCC patients excluding thrombocytopenia.