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Refining Prognosis in Chemoembolization for Hepatocellular Carcinoma: Immunonutrition and Liver Function
Lukas Müller1, Felix Hahn1, Aline Mähringer-Kunz1
1Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
Cancers
|August 27, 2021
Summary
The ALBI-PNI score, combining liver function and nutritional status, accurately predicts survival in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE). This novel scoring system offers improved prognostic ability over existing methods for HCC treatment stratification.
Area of Science:
- Hepatology
- Oncology
- Medical Statistics
Background:
- Hepatocellular carcinoma (HCC) management requires accurate prognostic tools.
- Existing scoring systems for HCC, such as BCLC, have limitations in predicting outcomes for specific treatments like TACE.
- The combination of albumin-bilirubin (ALBI) grading and Prognostic Nutritional Index (PNI) has shown promise in predicting outcomes for HCC patients undergoing tumor ablation.
Purpose of the Study:
- To evaluate the prognostic performance of the combined ALBI-PNI score in treatment-naïve HCC patients undergoing transarterial chemoembolization (TACE).
- To compare the predictive accuracy of the ALBI-PNI score against individual ALBI grade, PNI, and other established HCC scoring systems.
Main Methods:
- Retrospective analysis of 280 treatment-naïve HCC patients treated with TACE between 2010 and 2020.
- Assessment of overall survival (OS) based on ALBI grade, PNI, and the combined ALBI-PNI score.
- Comparison of prognostic ability using Concordance Index (C-Index) for ALBI-PNI versus ALBI, PNI, BCLC, HAP, mHAP-II, and Six-and-Twelve scores.
Main Results:
- Both advanced ALBI grade (2-3) and low PNI were significantly associated with reduced median overall survival (OS).
- The combined ALBI-PNI score demonstrated a significant gradient in median OS across its categories (39.0, 20.1, 10.3, and 5.4 months; p < 0.001).
- The ALBI-PNI score achieved a higher C-Index (0.69) compared to individual ALBI (0.65), PNI (0.64), and other established scores (BCLC 0.66, HAP 0.60, mHAP-II 0.59, Six-and-Twelve 0.55).
Conclusions:
- The ALBI-PNI score is a highly predictive tool for overall survival in HCC patients undergoing TACE.
- This easy-to-calculate score integrates liver function (ALBI) and immunonutritional status (PNI), offering superior prognostic stratification.
- The ALBI-PNI score represents a promising tool for personalized treatment strategies in HCC patients undergoing TACE.
