Overall Survival and the Impact of Albumin-bilirubin Grade in Patients with Advanced Hepatocellular Carcinoma: Data from a Tertiary Care Hospital in a Lower-middle-income Country.
Mohammad Ss Naviwala, Mahnoor Tariq, Faiza Ahmed, Warda Saleem, Waqas A Khan, Adeeba Zaki, Munira Moosajee, Yasmin A Rashid
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Abstract
Background and aim: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Most patients are diagnosed at an advanced stage, limiting their treatment options. The traditional assessment of liver function using the Child-Pugh score has limitations due to its subjectivity. The albumin-bilirubin (ALBI) grade delivers a more precise evaluation of liver function. This study examines overall survival (OS) in advanced HCC patients treated with first-line systemic therapy and the impact of ALBI grading on these outcomes.
Materials and methods: A total of 104 patients with advanced HCC treated between January 2017 and December 2023 with one of the three first-line therapy options: Sorafenib, lenvatinib or atezolizumab/bevacizumab were retrospectively analyzed. The Kaplan-Meier method was utilized to examine the survival results, and the log-rank test was employed to evaluate the variations in survival among ALBI grades and therapy types. Cox proportional hazards regression examined the impact of ALBI grading and other covariates on OS, with a significance threshold of p < 0.05 for the multivariable model.
Results: The median age of HCC patients was 58.5 years, with 70% males, and a primary etiology of hepatitis C (43%). The median OS and time to progression (TTP) in this cohort were 9 months and 3.25 months. In ALBI grade I patients, the OS was 21 months, while in grade II or III patients, it was just 5 months. Treatment-related side effects necessitated dose reductions in over 84% of patients. Albumin-bilirubin grade, Child-Pugh class, and treatment modifications due to adverse effects were significant predictors of survival.
Conclusion: Lenvatinib appears to have better survival outcomes compared to other options. The albumin-bilirubin grading is a useful method for evaluating liver function and forecasting survival rates for individuals with HCC.
Clinical significance: Our findings support the use of ALBI grading in clinical decision-making for advanced HCC.
How to cite this article: Naviwala MSS, Tariq M, Ahmed F, et al. Overall Survival and the Impact of Albumin-bilirubin Grade in Patients with Advanced Hepatocellular Carcinoma: Data from a Tertiary Care Hospital in a Lower-middle-income Country. Euroasian J Hepato-Gastroenterol 2024;14(2):251-257.
背景和目的：肝细胞癌（HCC）是世界范围内癌症相关死亡的主要原因。大多数患者被诊断为晚期，限制了他们的治疗选择。传统的使用Child-Pugh评分评价肝功能存在主观性的局限性。白蛋白胆红素（ALBI）分级提供了更精确的肝功能评估。本研究探讨了接受一线全身治疗的晚期HCC患者的总生存期（OS）以及ALBI分级对这些结果的影响。材料和方法：回顾性分析2017年1月至2023年12月期间接受索拉非尼、lenvatinib或atezolizumab/bevacizumab三种一线治疗方案之一治疗的104例晚期HCC患者。采用Kaplan-Meier法检查生存结果，采用log-rank检验评估不同ALBI分级和治疗类型的生存差异。Cox比例风险回归检验了ALBI分级及其他协变量对OS的影响，多变量模型的显著性阈值为p < 0.05。结果：HCC患者的中位年龄为58.5岁，男性占70%，主要病因为丙型肝炎（43%）。该队列的中位生存期和进展时间（TTP）分别为9个月和3.25个月。在ALBI I级患者中，OS为21个月，而II或III级患者仅为5个月。治疗相关的副作用导致超过84%的患者需要减少剂量。白蛋白胆红素分级、Child-Pugh分级和不良反应导致的治疗改变是生存的重要预测因素。结论：与其他选择相比，Lenvatinib似乎具有更好的生存结果。白蛋白-胆红素分级是HCC患者评估肝功能和预测生存率的有效方法。临床意义：我们的研究结果支持在晚期HCC的临床决策中使用ALBI分级。本文摘自：Naviwala MSS， Tariq M, Ahmed F，等。晚期肝细胞癌患者的总生存率和白蛋白-胆红素分级的影响：来自中低收入国家三级医院的数据中华肝病与胃肠病杂志；2009;14(2):251-257。
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