Construction and Validation of TACE Therapeutic Efficacy by ALR Score and Nomogram: A Large, Multicenter Study

Figures & data

Table 1 Baseline Characteristics of the ALR-Low, ALR-Intermediate and ALR-High Cohort

Variable	Total	ALR-Low	ALR-Intermediate	ALR-High	P
Patient	1112	272(0.24)	469(0.42)	371(0.33)
Age>60	406(0.37)	109(0.27)	185(0.46)	112(0.28)	0.009
Sex					0.084
Male	959(0.86)	230(0.24)	397(0.41)	332(0.35)
Female	153(0.14)	42(0.27)	72(0.47)	39(0.25)
Etiology					0.750
HBV	696(0.63)	165(0.24)	296(0.43)	235(0.34)
Non-HBV	416(0.37)	107(0.26)	173(0.42)	136(0.33)
Child-Pugh stage					<0.001
A	799(0.72)	235(0.29)	336(0.42)	228(0.29)
B	298(0.27)	37(0.12)	123(0.41)	138(0.46)
C	15(0.01)		10(0.67)	5(0.33)
Macrovascular invasion	631(0.57)	143(0.23)	269(0.43)	219(0.35)	0.248
Extrahepatic metastasis	252(0.23)	46(0.18)	104(0.41)	102(0.4)	0.006
BCLC stage					<0.001
B	197(0.18)	75(0.38)	78(0.4)	44(0.22)
C	901(0.81)	197(0.22)	382(0.42)	322(0.36)
D	14(0.01)		9(0.64)	5(0.36)
Lym-R≤21.7	605(0.54)		234(0.39)	371(0.61)	<0.001
AST>57.1	606(0.54)		235(0.39)	371(0.61)	<0.001

Abbreviations: HBV, hepatitis B virus; BCLC, Barcelona Clinic Liver Cancer; Lym-R, Lymphocyte ratio; AST, Aspartate transaminase.

Table 2 Univariable and Multivariable Cox Regression Analyses of Prognostic Factors in Train Cohort

	Univariable		Multivariable
	HR (95% CI)	P	HR (95% CI)	P
Sex (male/female)	1.011(0.795–1.285)	0.93
PVTT	1.588(1.345–1.876)	<0.001	1.269(1.048–1.537)	0.014
Age>60	0.912(0.768–1.083)	0.294
Child-Pugh A vs B / C	1.529(1.275–1.834)	<0.001	1.257(1.036–1.524)	0.02
BCLC stage B vs C vs D	1.62(1.275–2.059)	<0.001
B	1	<0.001
C	0.701(0.284–1.732)	0.442
D	1.137(0.471–2.746)	0.775
HBV (yes/no)	1.068(0.9–1.267)	0.451
Number of tumor (≥ 2/ < 2)	1.321(1.048–1.665)	0.018	1.374(1.079–1.748)	0.01
ALR score		<0.001		<0.001
0	1		1
1	0.395(0.313–0.497)	<0.001	1.467(1.162–1.854)	0.001
2	0.623(0.517–0.75)	<0.001	2.056(1.576–2.682)	<0.001
Plt (< 100,000/ ≥ 100,000/μL)	0.949(0.789–1.141)	0.576
ALT (≥ 40/ < 40 U/L)	1.19(1.007–1.406)	0.041
ALP(≥ 125/ < 125 U/L)	1.644(1.377–1.962)	<0.001
Extrahepatic metastases (yes/no)	1.588(1.318–1.913)	<0.001	1.303(1.069–1.587)	0.009
Lymph node metastasis (yes/no)	1.151(0.973–1.362)	0.101

Abbreviations: HR, Hazard Ratio; PVTT, portal vein tumor thrombus; Plt, Platelet; ALT, alanine transaminase; ALP, Alkaline Phosphatase.

Figure 1 Restricted cubic spline analyses for Lym-R (a) and AST (b).

Figure 2 Kaplan-Meier survival curves according to ALR score. (a) Overall survival according to ALR points in the pooled cohort. (b) Training cohort. (c) Valid cohort. (d) TACE plus targeted therapy cohort.

Figure 3 Time-dependent receiver operating characteristic curves of ALR score for overall survival in HCC patients. AUC area under the curve.

Figure 4 Nomogram used to evaluate survival.

Table 3 Efficacy According to ALR Score in TACE Plus Targeted Therapy with Immunotherapy Set

	ALR-Low, n=15	ALR-Intermediate, n=27	ALR-High, n=19
Overall survival
Median (95% CI), months	Not reached	17.1	15.8
HR (95% CI)	–	10.7-NA	9.8-NA