Prognostic Performance of Ten Liver Function Models in Patients with Hepatocellular Carcinoma Undergoing Radiofrequency Ablation

Abstract

Liver functional capacity is a crucial survival determinant for hepatocellular carcinoma (HCC). Noninvasive models were proposed to assess hepatic reserve, but their performance in outcome prediction is unclear. We aimed to investigate 10 currently used liver function models in HCC patients undergoing radiofrequency ablation (RFA). A total 499 HCC patients were prospectively identified. Homogeneity and corrected Akaike information criteria (AICc) were compared. Cox proportional hazards model was used to identify independent survival predictors. Significance survival differences were found across 10 noninvasive models (all p < 0.001) except for GUCI and APRI grade 2 vs 3, and King’s score grade 1 vs 2. Among these models, ALBI grade showed the highest homogeneity and lowest AICs value, indicating a better prognostic performance. Within Child-Turcotte-Pugh (CTP) score 5 group, significant survival difference was demonstrated between ALBI grade 1 and 2 (p < 0.001); for those with CTP score 6 or higher, only ALBI grade 2 and 3 showed survival difference (p < 0.001). Cox analysis disclosed that ALBI grade, tumor size and performance status were independent prognostic predictors. There was significant correlation between CTP score and other 9 models. We conclude that ALBI grade may serve as objective and feasible surrogate for prognostic prediction in HCC patients undergoing RFA.

Evolution of etiology, presentation, management and prognostic tool in hepatocellular carcinoma

“…The criteria of surgical resection for HCC were (1) patients with tumor involving no more than three Healey's segments, (2) Child-Turcotte-Pugh (CTP) class A with less than 25% of retention of indocyanine green 15 min after injection, and (3) no main portal trunk invasion or distant metastasis 20 . Radiofrequency ablation (RFA) was indicated in patients who had preserved liver function but were not eligible for surgical resection 17,21 . Transarterial chemoembolization (TACE) was performed in patients who had unresectable lesions or unwilling to receive curative treatment in the absence of distant metastasis and hepatic decompensation 14 .…”

Reply to: Correspondence concerning “Development of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection”

“…10,11 Its performance is at least as good or, more often, better than the Child-Pugh score. 12 Yan et al, 2 expressed surprise that ALBI, a measure of liver function, entered our early recurrence models since liver function is usually considered to be a factor influencing long term survival after HCC resection and indeed we have previously confirmed this in relation to ALBI. 13 Hsu et al, also reported, in a study of over 1,900 patients undergoing resection, that ALBI was an independent factor associated with early recurrence.…”

Current Status Regarding Tumour Progression, Surveillance, Diagnosis, Staging, and Treatment Of HCC: A Literature Review

“…The HCC surveillance can also be detected by CT and MRI. Despite the high cost of examination compared with ultrasound, it is useful in patients in whom it cannot be achieved by US, especially in Many systems can be used to detect the HCC staging such as Barcelona Clinic Liver Cancer (BCLC), Japan Integrated staging (JIS), Cancer of Liver Italian Program (CLIP) score and American Joint Committee on Cancer (AJCC) to estimate the liver dysfunction severity [35] but their performance in outcome prediction is unclear. We aimed to investigate 10 currently used liver function models in HCC patients undergoing radiofrequency ablation (RFA).…”

“…Moreover, many noninvasive liver function models can be used to assess the hepatic injury severity due to the HCC development such as the albumin-bilirubin (ALBI) grade, platelet-albumin-bilirubin (PALBI) grade, and albumin-to-alkaline phosphatase ratio (AAPR). Another model can also be used to assess the liver dysfunction in HCC know as model for an end-stage liver disease (MELD) which depends on prothrombin, creatinine and serum bilirubin [35] but their performance in outcome prediction is unclear. We aimed to investigate 10 currently used liver function models in HCC patients undergoing radiofrequency ablation (RFA).…”