Prognostic Performance of Albumin-Bilirubin Grade With Artificial Intelligence for Hepatocellular Carcinoma Treated With Transarterial Chemoembolization Combined With Sorafenib.

To establish albumin-bilirubin (ALBI) grade-based and Child-Turcotte-Pugh (CTP) grade-based nomograms, as well as to develop an artificial neural network (ANN) model to compare the prognostic performance and discrimination of these two grades for hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) combined with sorafenib as an initial treatment. This multicenter retrospective study included patients from three hospitals between January 2013 and August 2018. In the training cohort, independent risk factors associated with overall survival (OS) were identified by univariate and multivariate analyses. The nomograms and ANN were established and then validated in two validation cohorts. A total of 504 patients (319, 61, and 124 patients from hospitals A, B, and C, respectively) were included. The median OS was 15.2, 26.9, and 14.8 months in the training cohort and validation cohorts 1 and 2, respectively (P = 0.218). In the training cohort, both ALBI grade and CTP grade were identified as independent risk factors. The ALBI grade-based and CTP grade-based nomograms were established separately and showed similar prognostic performance and discrimination when validated in the validation cohorts (C-index in validation cohort 1: 0.799 vs. 0.779, P = 0.762; in validation cohort 2: 0.700 vs. 0.693, P = 0.803). The ANN model showed that the ALBI grade had higher importance in survival prediction than the CTP grade. The ALBI grade and CTP grade have comparable prognostic performance for HCC patients treated with TACE combined with sorafenib. ALBI grades 1 and 2 have the potential to act as a stratification factor for clinical trials on the combination therapy of TACE and systemic therapy.

Zhong BY ，Yan ZP ，Sun JH ，Zhang L ，Hou ZH ，Yang MJ ，Zhou GH ，Wang WS ，Li Z ，Huang P ，Zhang S ，Zhu XL ，Ni CF ... -  《Frontiers in Oncology》

Nomogram and Artificial Neural Network for Prognostic Performance on the Albumin-Bilirubin Grade for Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization.

To construct the albumin-bilirubin (ALBI) grade and the Child-Turcotte-Pugh (CTP) score based on nomograms, as well as to develop an artificial neural network (ANN) to compare the prognostic performance of the 2 scores for hepatocellular carcinoma (HCC) that has undergone transarterial chemoembolization. This multicentric retrospective study included patients with HCC who underwent transarterial chemoembolization monotherapy as an initial treatment at 4 institutions between January 2008 and December 2016. In the training cohort, significant risk factors associated with overall survival (OS) were identified by univariate and multivariate analyses. The prognostic nomograms and ANN were established and then validated in 2 validation cohorts. A total of 838 patients (548, 115, and 175 in the training cohort and validation cohorts 1 and 2, respectively) were included. The median OS was 10.4, 15.7, and 9.2 months in the training cohort and validation cohorts 1 and 2, respectively. In the training cohort, both ALBI grade and CTP score were identified as significant risk factors. The ALBI grade and CTP score based on nomograms were established separately and showed similar prognostic performance when assessed externally in validation cohorts (C-index in validation cohort 1: 0.823 vs 0.802, P = .417; in validation cohort 2: 0.716 vs 0.729, P = .793). ANN showed that ALBI grade had higher importance on survival prediction than CTP score. ALBI grade performs at least no worse than CTP score regarding survival prediction for HCC receiving transarterial chemoembolization. Considering the easy application, ALBI grade has the potential to be regarded as an alternative to CTP score.

Zhong BY ，Ni CF ，Ji JS ，Yin GW ，Chen L ，Zhu HD ，Guo JH ，He SC ，Deng G ，Zhang Q ，Li PC ，Yu H ，Song JJ ，Teng GJ ... -  《-》

Comparison of albumin-bilirubin grade, platelet-albumin-bilirubin grade and Child-Turcotte-Pugh class for prediction of survival in patients with large hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation.

Ni JY ，Fang ZT ，An C ，Sun HL ，Huang ZM ，Zhang TQ ，Jiang XY ，Chen YT ，Xu LF ，Huang JH ... -  《-》

Comparison of albumin-bilirubin grade versus Child-Pugh score in predicting the outcome of transarterial chemoembolization for hepatocellular carcinoma using time-dependent ROC.

The Child-Pugh score has been used extensively to assess hepatic function and predict post-treatment outcomes in patients with hepatocellular carcinoma (HCC). Recently, the albumin-bilirubin (ALBI) grade has been put forward as an objective method of evaluating liver function and predicting overall survival (OS) in HCC patients. Transarterial chemoembolization (TACE) is considered to be effective in prolonging OS among intermediate-stage HCC patients. This study aimed to explore and compare the performance of ALBI grade and Child-Pugh score in predicting outcomes for HCC patients who underwent TACE. There were a total of 221 consecutive HCC patients enrolled in this study, all of whom received TACE and were enrolled retrospectively. The Kaplan-Meier method and time-dependent receiver operating curves (ROC) were used to estimate the discriminatory ability and survival prediction accuracy of ALBI grade and Child-Pugh score in predicting postoperative OS. Univariate and multivariate Cox regression analyses were performed to evaluate the prognostic factors for OS. Of the patients enrolled in the study, 106 (48.0%) were ALBI grade 1 and 115 (52.0%) were ALBI grade 2. Overall survival differed significantly between patients with ALBI-1 and ALBI-2 [hazard ratio (HR), 3.032; 95% CI, 2.019-4.555, P<0.001]. With regard to Child-Pugh scores, 160 (72.4%) patients had a score of A5 and 61 (27.6%) had a score of A6. There was also a difference in overall survival between patients with Child-Pugh-A5 and Child-Pugh-A6 (HR, 1.548; 95% CI, 1.066-2.247, P=0.022). In multivariate analyses, both ALBI grade and Child-Pugh score could significantly stratify the patients with different OS (HR, 2.994 and 1.545, P<0.001 and P=0.026 for ALBI grade and Child-Pugh score, respectively). Furthermore, time-dependent ROC analysis and its subgroup analyses demonstrated that the ALBI grade had a better discriminatory ability than Child-Pugh score in predicting survival. In stratifying prognosis for HCC patients who had received TACE therapy, the ALBI grade provided better prognostic performance and discrimination of liver function than Child-Pugh score. These results suggest that ALBI grade could provide an alternative liver function grading system for stratification of patients with HCC.

Zhao S ，Zhang T ，Li H ，Wang M ，Xu K ，Zheng D ，Du X ，Liu L ... -  《-》

Albumin-bilirubin index and platelet-albumin-bilirubin index contribute to identifying survival benefit candidates in patients with hepatocellular carcinoma and Child-Pugh grade A undergoing transcatheter arterial chemoembolization with sorafenib treatmen

Combined therapy of transcatheter arterial chemoembolization (TACE) with sorafenib is used for a large number of patients with intermediate-stage or advanced-stage hepatocellular carcinoma (HCC), but its implementation is limited by the evaluation of pre-treatment liver function reserve. This study aimed to validate the performance of the albumin-bilirubin index (ALBI) and platelet-albumin-bilirubin index (PALBI) in predicting survival benefits in patients with HCC and Child-Pugh grade A receiving TACE combined with sorafenib treatment. From 2004 to 2018, 418 patients with intermediate/advanced-stage HCC and Child-Pugh grade A receiving TACE combined with sorafenib treatment were retrospectively enrolled. The predictive performance of ALBI and PALBI was explored by survival analysis and receiver operating characteristic curve (ROC) analysis. The median overall survival (mOS) was 24 and 12 months in patients with ALBI grade 1 and grade 2, respectively. The mOS of patients with PALBI grade 1, grade 2, and grade 3 was 23, 16, and 7 months, respectively. The multivariate analysis showed that ALBI grade 2 [hazard ratio (HR) =1.39, 95% confidence interval (CI): 1.11-1.74] and PALBI grade 3 (HR =3.72, 95% CI: 2.26-6.06) were associated with unfavorable prognosis. The ROC analysis revealed that ALBI and PALBI scores had better prediction performance compared with the Child-Pugh score. Subgroup analysis confirmed that by using ALBI or PALBI, patients could be stratified into subgroups with different liver function reserves and distinctive prognosis, regardless of Barcelona Clinic Liver Cancer (BCLC) stage, combination modality, or α-fetoprotein (AFP) levels. Both ALBI and PALBI could predict prognosis in patients with HCC and Child-Pugh grade A receiving TACE and sorafenib. Patients with ALBI or PALBI grade 1 harbored a more favorable survival outcome compared with those with ALBI or PALBI grade 2-3, and hence should be recommended as the best candidates for TACE combined with sorafenib treatment.

Hu K ，Yuan J ，Tang B ，Zhang F ，Lu S ，Chen R ，Zhang L ，Ren Z ，Yin X ... -  《-》