Modified albumin-bilirubin grade and alpha-fetoprotein score for predicting prognosis of hepatocellular carcinoma patients undergoing conventional transarterial chemoembolization

Background: Predicting post-treatment prognosis in hepatocellular carcinoma (HCC) patients undergoing conventional transarterial chemoembolization (cTACE) is challenging due to tumor heterogeneity. We here assessed the utility of the modified albumin‒bilirubin grade and α-fetoprotein (mALF) score for predicting the prognosis of cTACE-treated HCC patients. Methods: This retrospective observational study included 206 early- and intermediate-stage HCC patients who had undergone cTACE. We calculated baseline and post-treatment mALF scores by assigning one point for a modified albumin-bilirubin grade of 2b or 3, and one point for an alpha-fetoprotein level of ≥ 100 ng/mL. Results: The baseline mALF scores were 0, 1, and 2 points for 66 patients (32%), 95 patients (47%), and 45 patients (21%), respectively, and their median survival times were 42.3 months, 21.1 months, and 14.0 months, respectively. The baseline mALF score was also associated with overall survival, independent of the Barcelona Clinic Liver Cancer stage and the tumor burden score (hazard ratio, 1.97; 95% confidence interval, 1.56–2.49; p < 0.001). One month after cTACE, the mALF score had decreased in 26 patients and increased in 31 patients. In those with a baseline mALF score of 0 or 1, the increased mALF score was significantly associated with shorter survival periods after cTACE. Conclusions: The baseline mALF score was useful in stratifying HCC patients undergoing cTACE, according to post-treatment prognosis. Increased mALF scores after cTACE were associated with poor prognosis in patients with a baseline mALF score of 0 or 1. Assessment of baseline and post-treatment mALF scores may help in predicting prognosis in HCC patients following cTACE.