Prognostic Value of Albumin-Bilirubin Grade (ALBI) in Patients Underwent Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma

Introduction: Various noninvasive markers are under evaluation to predict the severity of liver dysfunction. However, the prognostication of these markers in patients with hepatocellular carcinoma (HCC) is yet to be known. We aimed to determine the prognostic value of the albumin-bilirubin grade (ALBI) in patients who underwent Transarterial Chemoembolization (TACE) for unresectable Hepatocellular carcinoma. Methods: All patients who underwent TACE from 2013 to 2017 at the department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation, Pakistan were included. Patients' baseline and tumor characteristics were recorded. Computerized tomography scan was performed at 1 and 3 months after TACE to assess response. All the patients were assessed for survival at the last follow-up. Results: In 71 patients majority were males 57 (80.3 %) with a mean age of 51.9± 12.1 years (range: 18-76 years). The mean follow-up period was of 12.5±10.7 months. A total of 31 (43.7%) patients had only one session of TACE, 17 (23.9%) underwent 2, while 11 patients (15.5%) had 3 or more sessions. On univariate analysis, significant factors that predicted survival included serum bilirubin (p=0.02), esophageal varices (p=0.002), ALBI grade (p=0.001), tumor size (p=0.005), and patients' age (p=0.001). Cox regression analysis showed that ALBI grade (p=0.016) and tumor size of < 5cm (P=0.049) were both better predictor of survival. Conclusion: The liver functional reserve is a critical concern along with the tumor progression in predicting the prognosis of HCC. Conventional score like Child-Turcotte-Pugh (CTP) has inter-observer variation and has been designed for cirrhotic patients. However, HCC can also occur in non- cirrhotic patients.1 ALBI grade was found superior to the CTP score for the assessment of liver dysfunction amongst patients with HCC.1 Li C et al reported that post operative increase in ALBI grade was associated with a poor overall survival and increased risk of HCC recurrence.2 Moreover, Aravind et al also showed that the ALBI grade as a better predictor of survival in patients with mild liver disease & HCC who underwent TACE.3 Similarly, we also observed that ALBI grade and tumor size were good predictor of survival in HCC patients undergoing TACE.