Comparison of albumin-bilirubin grade versus Child-Pugh score in predicting the outcome of transarterial chemoembolization for hepatocellular carcinoma using time-dependent ROC

Shoujie Zhao; Ting Zhang; Huichen Li; Mengmeng Wang; Ke Xu; Desha Zheng; Xilin Du; Lei Liu

doi:10.21037/atm.2020.02.124

Comparison of albumin-bilirubin grade versus Child-Pugh score in predicting the outcome of transarterial chemoembolization for hepatocellular carcinoma using time-dependent ROC

Ann Transl Med. 2020 Apr;8(8):538. doi: 10.21037/atm.2020.02.124.

Authors

Shoujie Zhao¹, Ting Zhang², Huichen Li³, Mengmeng Wang⁴, Ke Xu⁵, Desha Zheng⁶, Xilin Du¹, Lei Liu⁷

Affiliations

¹ Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
² Department of Nuclear Medicine, The 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China.
³ The State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.
⁴ Department of Drug and Equipment, Aeromedicine Identification and Training Centre of Air Force, Xi'an 710069, China.
⁵ Department of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.
⁶ Department of Nursing, Fourth Military Medical University, Xi'an 710032, China.
⁷ Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.

Abstract

Background: The Child-Pugh score has been used extensively to assess hepatic function and predict post-treatment outcomes in patients with hepatocellular carcinoma (HCC). Recently, the albumin-bilirubin (ALBI) grade has been put forward as an objective method of evaluating liver function and predicting overall survival (OS) in HCC patients. Transarterial chemoembolization (TACE) is considered to be effective in prolonging OS among intermediate-stage HCC patients. This study aimed to explore and compare the performance of ALBI grade and Child-Pugh score in predicting outcomes for HCC patients who underwent TACE.

Methods: There were a total of 221 consecutive HCC patients enrolled in this study, all of whom received TACE and were enrolled retrospectively. The Kaplan-Meier method and time-dependent receiver operating curves (ROC) were used to estimate the discriminatory ability and survival prediction accuracy of ALBI grade and Child-Pugh score in predicting postoperative OS. Univariate and multivariate Cox regression analyses were performed to evaluate the prognostic factors for OS.

Results: Of the patients enrolled in the study, 106 (48.0%) were ALBI grade 1 and 115 (52.0%) were ALBI grade 2. Overall survival differed significantly between patients with ALBI-1 and ALBI-2 [hazard ratio (HR), 3.032; 95% CI, 2.019-4.555, P<0.001]. With regard to Child-Pugh scores, 160 (72.4%) patients had a score of A5 and 61 (27.6%) had a score of A6. There was also a difference in overall survival between patients with Child-Pugh-A5 and Child-Pugh-A6 (HR, 1.548; 95% CI, 1.066-2.247, P=0.022). In multivariate analyses, both ALBI grade and Child-Pugh score could significantly stratify the patients with different OS (HR, 2.994 and 1.545, P<0.001 and P=0.026 for ALBI grade and Child-Pugh score, respectively). Furthermore, time-dependent ROC analysis and its subgroup analyses demonstrated that the ALBI grade had a better discriminatory ability than Child-Pugh score in predicting survival.

Conclusions: In stratifying prognosis for HCC patients who had received TACE therapy, the ALBI grade provided better prognostic performance and discrimination of liver function than Child-Pugh score. These results suggest that ALBI grade could provide an alternative liver function grading system for stratification of patients with HCC.

Keywords: Child-Pugh score; albumin-bilirubin grade (ALBI grade); hepatocellular carcinoma (HCC); time-dependent receiver operating characteristic curve; transarterial chemoembolization (TACE).