Adding nutritional status to the original BCLC stage improves mortality prediction for hepatocellular carcinoma patients in HBV-endemic regions

Yan-Ting Lin; Po-Ting Lin; Chen-Chun Lin; Tsung-Han Wu; Li-Tong Liu; Chung-Wei Su; Wei Teng; Chun-Yi Tsai; Chien-Hao Huang; Wei-Ting Chen; Kun-Ming Chan; Chao-Wei Hsu; Chun-Yen Lin; Shi-Ming Lin; Rong-Nan Chien

Adding nutritional status to the original BCLC stage improves mortality prediction for hepatocellular carcinoma patients in HBV-endemic regions

Am J Cancer Res. 2023 Aug 15;13(8):3618-3628. eCollection 2023.

Authors

Yan-Ting Lin¹, Po-Ting Lin^{1

2}, Chen-Chun Lin^{1

2}, Tsung-Han Wu^{2

3}, Li-Tong Liu¹, Chung-Wei Su^{1

2}, Wei Teng^{1

2}, Chun-Yi Tsai^{2

3}, Chien-Hao Huang^{1

2}, Wei-Ting Chen^{1

2}, Kun-Ming Chan^{2

3}, Chao-Wei Hsu^{1

2}, Chun-Yen Lin^{1

2}, Shi-Ming Lin^{1

2}, Rong-Nan Chien^{1

2}

Affiliations

¹ Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
² College of Medicine, Chang-Gung University Taoyuan, Taiwan.
³ Department of General Surgery, Chang-Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.

PMID: 37693156
PMCID: PMC10492128

Abstract

Hepatocellular carcinoma (HCC) is associated with high mortality, especially in Asian populations where chronic HBV infection is a major cause. Accurate prediction of mortality can assist clinical decision-making. We aim to (i) compare the predicting ability of Barcelona Clinic Liver Cancer classification (BCLC) stage, neutrophil-to-lymphocyte ratio (NLR), and Albumin-Bilirubin (ALBI) score in predicting short-term mortality (one- and two-year) and (ii) develop a novel model with improved accuracy compared to the conventional models. This study enrolled 298 consecutive HCC patients from our hepatology department. The prognostic values for mortality were assessed by area under the receiver operating characteristic curve (AUROC) analysis. A novel model was established and internally validated using 5-fold cross-validation, followed by external validation in a cohort of 100 patients. The primary etiology of cirrhosis was hepatitis B virus (HBV), with 81.2% of HCC patients having preserved liver function. Significant differences were observed in hemoglobin (Hb) and serum albumin levels, which reflect patients' nutrition status, between patients who survived for one year and those who died. BCLC exhibited superior predictive accuracy compared to NLR but had borderline superiority to the ALBI score. Therefore, a novel model incorporating BCLC, Hb, and serum albumin was developed, internally and externally validated, as well as subgroup sensitivity analysis. The model exhibited significantly higher predictive accuracy for one- and two-year mortality than conventional prognostic predictors, with AUROC values of 0.841 and 0.805, respectively. The novel "BCLC-Nutrition Model", which incorporates BCLC, Hb, and serum albumin, may provide improved predictive accuracy for short-term mortality in HCC patients compared to commonly used prognostic scores. This emphasizes the importance of nutrition in the management of HCC patients.

Keywords: 5-fold cross-validation; Barcelona Clinic Liver Cancer (BCLC) stage; Hepatocellular carcinoma (HCC); albumin-bilirubin (ALBI) score; area under receiver operating characteristic curve (AUROC); internal and external validation; model building; neutrophil-lymphocyte ratio (NLR); nutritional status; short-term mortality; subgroup sensitivity analysis.