Comparison of Four Albumin-Based Liver Reserve Models (ALBI/EZ-ALBI/PALBI/PAL) against MELD for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Author:

Ho Shu-Yein123,Liu Po-Hong4,Hsu Chia-Yang5,Huang Yi-Hsiang367ORCID,Liao Jia-I6,Su Chien-Wei36ORCID,Hou Ming-Chih36,Huo Teh-Ia268ORCID

Affiliation:

1. Division of Gastroenterology and Hepatology, Min-Sheng General Hospital, Taoyuan 33044, Taiwan

2. Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan

3. School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan

4. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA

5. Department of Medicine, Renown Medical Center, Reno, NV 89502, USA

6. Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan

7. Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan

8. Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan

Abstract

(1) Background: The severity of liver functional reserve plays an important role in the management of hepatocellular carcinoma (HCC). Noninvasive models such as the model for end-stage liver disease (MELD), albumin-bilirubin (ALBI) grade and easy (EZ)-ALBI grade, platelet-albumin-bilirubin (PALBI) and platelet-albumin (PAL) are used to evaluate liver dysfunction. We aimed to compare the prognostic performance of these four albumin-based models against MELD in HCC patients undergoing transarterial chemoembolization (TACE). (2) Methods: A total of 1038 treatment naïve HCC patients who received TACE as the primary treatment were enrolled. A multivariate Cox model was used to determine independent survival predictors. (3) Results: Multivariate analysis revealed that higher serum creatinine and α-fetoprotein level, vascular invasion, large tumor size, ALBI grades 2–3, EZ-ALBI grades 2–3, PALBI grades 2–3, PAL grades 2–3, but not the MELD score, were independent predictors associated with decreased survival in different Cox models. Among these models, the PALBI grade had the highest homogeneity and lowest corrected Akaike information criteria value, followed by EZ-ALBI, PAL, ALBI and, lastly, MELD. (4) Conclusions: All four albumin-based liver reserve models are better prognostic tools than MELD score in HCC patients undergoing TACE. Of these, the PALBI score is the best model to evaluate the liver reserve and should be considered a surrogate marker in these patients.

Funder

Taipei Veterans General Hospital

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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