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ORIGINAL RESEARCH

Prognosis of Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization(MC-hccAI 001): Development and Validation of the ALFP Score

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Pages 1341-1351 | Received 12 Apr 2023, Accepted 27 Jul 2023, Published online: 11 Aug 2023

Figures & data

Figure 1 Flow diagram of the patients with hepatocellular carcinoma.

Abbreviations: TACE, transcatheter arterial chemoembolization; HCC, hepatocellular carcinoma; AFP, alpha-fetoprotein; PT, Prothrombin Time; AST, aspartate transaminase.
Figure 1 Flow diagram of the patients with hepatocellular carcinoma.

Table 1 Baseline Characteristics of Patients in the Training and Validation Sets (N=1805)

Table 2 Results of Univariate and Multivariate Analysis in the Training Set

Figure 2 The OS according to the ALFP score in the training and validation sets. (A) The median OS according to the ALFP score in the training set was as follows: 0 points (n = 112), 50.1 months (95% CI not applicable); 1 point (n = 484), 33.6 months (95% CI 27.4–39.8); 2 points (n = 540), 20.4 months (95% CI 18.0–22.8); and 3 points (n = 128), 12.7 months (95% CI 10.2–15.2); this amounted to a statistically significant difference (p < 0.001). (B) The median OS according to the ALFP score in the validation set was as follows: 0 points (n = 54), 42.5 months (95% CI 16.1–68.9); 1 point (n = 188), 32.6 months (95% CI 25.1–40.1); 2 points (n = 240), 20.4 months (95% CI 16.4–24.4); and 3 points (n = 59), 13.0 months (95% CI 0.0–27.3); this amounted to a statistically significant difference (p = 0.0019).

Abbreviations: CI, confidence interval; ALFP, score albumin–bilirubin grade, α-fetoprotein and prothrombin time score; OS, overall survival.
Figure 2 The OS according to the ALFP score in the training and validation sets. (A) The median OS according to the ALFP score in the training set was as follows: 0 points (n = 112), 50.1 months (95% CI not applicable); 1 point (n = 484), 33.6 months (95% CI 27.4–39.8); 2 points (n = 540), 20.4 months (95% CI 18.0–22.8); and 3 points (n = 128), 12.7 months (95% CI 10.2–15.2); this amounted to a statistically significant difference (p < 0.001). (B) The median OS according to the ALFP score in the validation set was as follows: 0 points (n = 54), 42.5 months (95% CI 16.1–68.9); 1 point (n = 188), 32.6 months (95% CI 25.1–40.1); 2 points (n = 240), 20.4 months (95% CI 16.4–24.4); and 3 points (n = 59), 13.0 months (95% CI 0.0–27.3); this amounted to a statistically significant difference (p = 0.0019).

Figure 3 The OS according to the ALFP score in the training and validation sets stratified by the diameter of tumor. (A) The median OS according to the ALFP score in the training set stratified by the diameter of tumor was as follows: The diameter of tumor ≤5 cm group, 0 points (n = 52), not applicable (95% CI not applicable); 1 point (n = 170), 54.9 months (95% CI not applicable); 2 points (n = 162), 50.0 months (95% CI 38.5–61.5); and 3 points (n = 44), 23.9 months (95% CI 12.3–35.5); this amounted to a statistically significant difference (p = 0.0077). The diameter of tumor >5 cm group, 0 points (n = 60), 31.8 months (95% CI 11.7–51.9); 1 point (n = 314), 20.3 months (95% CI 17.4–23.2); 2 points (n = 378), 15.6 months (95% CI 13.1–18.1); and 3 points (n = 84), 10.8 months (95% CI 8.2–13.4); this amounted not to a statistically significant difference (p < 0.001). (B) The median OS according to the ALFP score in the validation set stratified by the diameter of tumor was as follows: The diameter of tumor ≤5 cm group, 0 points (n = 26), 59.0 months (95% CI 38.8–79.2); 1 point (n = 69), 47.7 months (95% CI not applicable); 2 points (n = 70), 29.6 months (95% CI 19.1–40.1); and 3 points (n = 24), 27.0 months (95% CI 0.0–54.1); this amounted to a statistically significant difference (p = 0.015). The diameter of tumor >5 cm group, 0 points (n = 28), 21.6 months (95% CI 14.5–28.7); 1 point (n = 119), 25.1 months (95% CI 16.5–33.7); 2 points (n = 170), 16.3 months (95% CI 11.8–20.8); and 3 points (n = 35), 9.8 months (95% CI 2.8–16.8); this amounted not to a statistically significant difference (p = 0.092).

Abbreviations: CI, confidence interval; ALFP, score albumin–bilirubin grade, α-fetoprotein and prothrombin time score; OS, overall survival.
Figure 3 The OS according to the ALFP score in the training and validation sets stratified by the diameter of tumor. (A) The median OS according to the ALFP score in the training set stratified by the diameter of tumor was as follows: The diameter of tumor ≤5 cm group, 0 points (n = 52), not applicable (95% CI not applicable); 1 point (n = 170), 54.9 months (95% CI not applicable); 2 points (n = 162), 50.0 months (95% CI 38.5–61.5); and 3 points (n = 44), 23.9 months (95% CI 12.3–35.5); this amounted to a statistically significant difference (p = 0.0077). The diameter of tumor >5 cm group, 0 points (n = 60), 31.8 months (95% CI 11.7–51.9); 1 point (n = 314), 20.3 months (95% CI 17.4–23.2); 2 points (n = 378), 15.6 months (95% CI 13.1–18.1); and 3 points (n = 84), 10.8 months (95% CI 8.2–13.4); this amounted not to a statistically significant difference (p < 0.001). (B) The median OS according to the ALFP score in the validation set stratified by the diameter of tumor was as follows: The diameter of tumor ≤5 cm group, 0 points (n = 26), 59.0 months (95% CI 38.8–79.2); 1 point (n = 69), 47.7 months (95% CI not applicable); 2 points (n = 70), 29.6 months (95% CI 19.1–40.1); and 3 points (n = 24), 27.0 months (95% CI 0.0–54.1); this amounted to a statistically significant difference (p = 0.015). The diameter of tumor >5 cm group, 0 points (n = 28), 21.6 months (95% CI 14.5–28.7); 1 point (n = 119), 25.1 months (95% CI 16.5–33.7); 2 points (n = 170), 16.3 months (95% CI 11.8–20.8); and 3 points (n = 35), 9.8 months (95% CI 2.8–16.8); this amounted not to a statistically significant difference (p = 0.092).

Figure 4 The OS according to the ALFP score in the training and validation sets stratified by the No. of intrahepatic lesions. (A) The median OS according to the ALFP score in the training set stratified by the No. of intrahepatic lesions was as follows: The No. of intrahepatic lesions ≤3 group, 0 points (n = 54), not applicable (95% CI not applicable); 1 point (n = 191), 42.7 months (95% CI 27.4–58.0); 2 points (n = 201), 34.4 months (95% CI 21.4–47.4); and 3 points (n = 41), 16.8 months (95% CI 6.8–26.8); this amounted to a statistically significant difference (p = 0.002). The No. of intrahepatic lesions >3 group, 0 points (n = 58), 39.5 months (95% CI 23.6–55.4); 1 point (n = 293), 22.4 months (95% CI 14.5–30.3); 2 points (n = 339), 18.2 months (95% CI 16.0–20.4); and 3 points (n = 87), 10.8 months (95% CI 7.8–13.8); this amounted not to a statistically significant difference (p < 0.001). (B) The median OS according to the ALFP score in the validation set stratified by the No. of intrahepatic lesions was as follows: The No. of intrahepatic lesions ≤3 group, 0 points (n = 23), 59.0 months (95% CI 28.2–89.8); 1 point (n = 87), 39.3 months (95% CI 24.3–54.3); 2 points (n = 87), 35.6 months (95% CI 15.3–55.9); and 3 points (n = 17), 28.3 months (95% CI 3.0–53.6); this amounted not to a statistically significant difference (p = 0.35). The No. of intrahepatic lesions >3 group, 0 points (n = 31), 42.5 months (95% CI 7.9–77.1); 1 point (n = 101), 28.0 months (95% CI 11.2–44.8); 2 points (n = 152), 19.2 months (95% CI 15.1–23.3); and 3 points (n = 42), 12.5 months (95% CI 8.3–16.7); this amounted not to a statistically significant difference (p = 0.034).

Abbreviations: CI, confidence interval; ALFP, score albumin–bilirubin grade, α-fetoprotein and prothrombin time score; OS, overall survival.
Figure 4 The OS according to the ALFP score in the training and validation sets stratified by the No. of intrahepatic lesions. (A) The median OS according to the ALFP score in the training set stratified by the No. of intrahepatic lesions was as follows: The No. of intrahepatic lesions ≤3 group, 0 points (n = 54), not applicable (95% CI not applicable); 1 point (n = 191), 42.7 months (95% CI 27.4–58.0); 2 points (n = 201), 34.4 months (95% CI 21.4–47.4); and 3 points (n = 41), 16.8 months (95% CI 6.8–26.8); this amounted to a statistically significant difference (p = 0.002). The No. of intrahepatic lesions >3 group, 0 points (n = 58), 39.5 months (95% CI 23.6–55.4); 1 point (n = 293), 22.4 months (95% CI 14.5–30.3); 2 points (n = 339), 18.2 months (95% CI 16.0–20.4); and 3 points (n = 87), 10.8 months (95% CI 7.8–13.8); this amounted not to a statistically significant difference (p < 0.001). (B) The median OS according to the ALFP score in the validation set stratified by the No. of intrahepatic lesions was as follows: The No. of intrahepatic lesions ≤3 group, 0 points (n = 23), 59.0 months (95% CI 28.2–89.8); 1 point (n = 87), 39.3 months (95% CI 24.3–54.3); 2 points (n = 87), 35.6 months (95% CI 15.3–55.9); and 3 points (n = 17), 28.3 months (95% CI 3.0–53.6); this amounted not to a statistically significant difference (p = 0.35). The No. of intrahepatic lesions >3 group, 0 points (n = 31), 42.5 months (95% CI 7.9–77.1); 1 point (n = 101), 28.0 months (95% CI 11.2–44.8); 2 points (n = 152), 19.2 months (95% CI 15.1–23.3); and 3 points (n = 42), 12.5 months (95% CI 8.3–16.7); this amounted not to a statistically significant difference (p = 0.034).