Aim: It is unclear that the prognostic value of sarcopenia and albumin-bilirubin (ALBI) grade on patients with hepatocellular carcinoma (HCC) under transarterial chemoembolization(TACE).The purpose of this study was to explore the effect of sarcopenia and ALBI grade on the survival time of patients after TACE for HCC.
Method: 110 HCC patients receiving TACE were enrolled in this retrospective study from 2015 to 2019. Psoas muscle index (PMI) was calculated as the left-right area of the psoas muscle at the third lumbar vertebra, divided by height squared.Patients were classified into two groups (non-sarcopenia and sarcopenia) depending on an index < 6.36 and < 3.92 cm2 /m2 for men and women, respectively. According to the formula ALBI =(log10 bilirubin*0.66)+(albumin*-0.085),the patients were classified into 3 grade.We assessed whether PMI and ALBI grade have effect on overall survival (OS) .
Results: Of the patients enrolled in the study,80(72.7%) were sarcopenia,30(27.3%) were non-sarcopenia,and 32(29.09%),74(67.3%),4(3.6%) patients were be classified into ALBI 1,2,3 respectively. There were no significant differences in the number of deaths between non-sarcopenia and sarcopenia(non-sarcopenia 63.8%, sarcopenia 56.7%,p=0.496),but according to ALBI grouping, the number of deaths was significant(ALBI grade 1 46.9%,ALBI grade 2 and 3,67.9%,p=0.039).In univariate analyses,ALBI grade[ALBI 2, hazard ratio(HR)=2.323;95%CI,1.291-4.182,P=0.005; ALBI 3,HR=21.915;95%CI,6.441-74.569,P=0.000],Barcelona Clinic Liver Cancer staging system (BCLC stage)(BCLC B,HR=2.706;95%CI,1.147-6.388,P=0.023; BCLC C,HR=5.007;95%CI,2.024-12.386,P=0.000),number of tumours (>3) (HR=1.71;95%CI,1.061-2.757,P=0.028),maximum tumour diameter (>3 cm) (HR=3.042;95%CI,1.627-5.687,P=0.000) and metastasis(HR=2.056;95%CI, 1.062-3.981,P=0.033) were associated with poor OS,but sarcopenia had no effect on OS(HR=1.15;95%CI,0.664-1.993,P=0.618).Multivariate analysis showed that ALBI grade(ALBI 2, HR=1.941;95%CI,1.016-3.705,P=0.044;ALBI3,HR=10.688; 95%CI,2.51-45.502,P=0.001), metastasis(HR=2.925;95%CI, 1.257-6.808,P=0.013), maximum tumour diamete(>3 cm)(HR=2.335;95%CI, 1.341-4.068,P=0.003) could significantly stratify the patients with different OS.
Conclusion: ALBI grade is an important predictor of poor prognosis in HCC patients under TACE,but PMI doesn't contribute to prognostic stratification. These results suggest ALBI grade as another liver function grading system are independent predictors of OS,it is regrettable that PMI that reflects the nutritional status of the body could not provide clinical prognosis value.