Strategy for advanced hepatocellular carcinoma based on liver function and portal vein tumor thrombosis

Abstract

Tyrosine kinase inhibitor (TKI) therapy resulted in better prognosis for patients with hepatocellular carcinoma (HCC). However, some cases with Barcelona Clinic Liver Cancer (BCLC) stage C disease still had poor prognosis. This study aimed to investigate prognosis and characteristics of patients with HCC treated with TKI based on liver function and the extent of portal vein tumor thrombosis (PVTT). Methods: Patients receiving TKI therapy (n=345) were recruited retrospectively. Child-Pugh score and albumin-bilirubin (ALBI) score were used for assessment of liver function. The extent of PVTT was classified from Vp0 to Vp4. Radiotherapy or hepatic arterial infusion chemotherapy were carried out as additional therapy to TKI. The end point for this analysis was overall survival (OS). Results: A total of 291 and 54 patients received sorafenib and lenvatinib as first line TKI therapy, respectively. The median OS of patients treated with TKI were significantly stratified by ALBI grade (grade 1, 20.1 months; grade 2a, 16.3 months; grades 2b and 3, 9.8 months; P=0.0003). The classification of PVTT significantly stratified the prognosis of patients treated with TKI (median OS: Vp0, 18.5 months; Vp1/2, 14.4 months; Vp3/4, 5.5 months; P<0.0001). In the ALBI 2b/3 and Vp3/4 groups, the median OS of patients treated with TKI and additional therapies was significantly longer than those treated with TKI only (9.2 months vs.. 3.6 months; P=0.0129). Conclusion: Liver function and PVTT are useful for stratifying prognosis of HCC patients treated with TKI. The applicative classification could lead to appropriate therapy and better prognosis.

Easy clinical predictor for low BCAA to tyrosine ratio in chronic liver disease patients with hepatocellular carcinoma: Usefulness of ALBI score as nutritional prognostic marker

“…The reported ALBI cut‐off value (−2.18) for npRQ (<0.85) was near the border of mALBI 2a and 2b (ALBI score −2.27). A recent study of the efficacy of the predictive value of mALBI divided into four different grades, a more accurate assessment tool for hepatic function than Child‐Pugh class, 34 reported that mALBI grade 1 and 2a indicated better prognosis even in unresectable HCC patients treated with molecular targeting agents 38‐43 . Decline of BTR (≤4.4) was shown to be a prognostic factor in patients with early HCC treated curatively in the present results (HR 1.852, p = 0.005), and the predictive value of ALBI score for low BTR (≤4.4) was −2.588, which was an approximation of cut‐off value of ALBI grade 1, and those of BTR for mALBI grade 2a and 2b were 4.509 (AUC 0.768) and 4.155 (AUC 0.770).…”

Prognosis of intrahepatic cholangiocarcinoma stratified by albumin–bilirubin grade

“…Some studies about the prognosis of HCC patients with liver function exist, especially regarding ALBI grade and PVTT 10–14 . However, only a few reports about patients with ICC exist, and they mainly focused on surgical cases 20,21 .…”

“…The diagnosis of ICC was based on pathologically proven ICC or on radiologic findings, in accordance with the criteria of practice guidelines and reviews 1,2,9 . The extent of PVTT was classified as follows: Vp0, no PVTT; Vp1, segmental PV invasion; Vp2, right anterior or posterior PV; Vp3, right or left PV; and Vp4, main trunk and/or contralateral portal vein branch to the primarily involved lobe 10–12 . Child–Pugh classification, ALBI, and mALBI grades were used for liver function assessment.…”

Easy albumin–bilirubin score as a new prognostic predictor in hepatocellular carcinoma

“…4,5 For unresectable or advanced stage HCC, TACE, and systemic therapy (including targeted/immunotherapy) are major treatment options. 4,6,7 The management and prognosis of HCC largely depend on tumor burden and liver functional reserve. 8 Traditionally, the CTP score, including serum albumin, bilirubin, INR of PT, ascites, and hepatic encephalopathy, are utilized to assess the severity of liver dysfunction.…”