Prognostic Value of Changes in Combined Child-Pugh Class and ALBI Grade in Hepatocellular Carcinoma Treated with Transcatheter Intra-Arterial Therapy Plus Targeted Therapy and PD-(L)1 Inhibitors.
{"title":"Prognostic Value of Changes in Combined Child-Pugh Class and ALBI Grade in Hepatocellular Carcinoma Treated with Transcatheter Intra-Arterial Therapy Plus Targeted Therapy and PD-(L)1 Inhibitors.","authors":"Xiaoyu Huang, Xiaojing Cao, Yaqing Kong, Fan Tang, Tianhao Cong, Xiang Zhou","doi":"10.2147/JHC.S490439","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to investigate liver function changes in hepatocellular carcinoma (HCC) patients treated with transcatheter intra-arterial therapy plus molecular targeted agents and programmed cell death-1 (ligand-1) inhibitors, and evaluate the prognostic significance of the combination of Child-Pugh (CP) class and albumin-bilirubin (ALBI) grade (CP/ALBI).</p><p><strong>Methods: </strong>This is a retrospective study. A total of 149 patients from 2019 to 2023 in China were included. Changes in CP score, ALBI grade, and CP/ALBI grade at 4-8 weeks, 12-16 weeks, and 20-28 weeks post-treatment was evaluated. Cox regression models identified prognostic factors for overall survival (OS) and progression-free survival (PFS). The discrimination of the scoring systems was determined by concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC).</p><p><strong>Results: </strong>Among CP-A patients (n = 137), 11.68% (n = 16) progressed to CP-B by 20-28 weeks (<i>p</i> < 0.001). Multivariate analysis identified CP/ALBI grade at 20-28 weeks as an independent prognostic factor for OS (grade 2 vs grade 1, hazard ratio [HR] 3.12, <i>p</i> < 0.001; grade 3 vs grade 1, HR 4.95, <i>p</i> < 0.001) and at 4-8 weeks for PFS (grade 3 vs grade 1, HR 3.26, <i>p</i> = 0.002). The combination of CP/ALBI grade and baseline clinical prognostic factors (Eastern Cooperative Oncology Group Performance Status, Barcelona Clinic Liver Cancer stage, tumor size) demonstrated superior discrimination for OS (C-index: 0.74-0.77; time-dependent AUC: 0.74-0.92). Baseline factors associated with maintaining CP/ALBI grade 1 in CP-A patients included ALBI grade 1 (odds ratio [OR] 3.09, <i>p</i> = 0.030) and aspartate aminotransferase < 40 U/L (OR 3.35, <i>p</i> = 0.017).</p><p><strong>Conclusion: </strong>A small but notable proportion of HCC patients experienced liver function deterioration within 28-week of combined treatment. Dynamic monitoring of CP/ALBI grade provides valuable prognostic insights for patient stratification.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"12 ","pages":"481-496"},"PeriodicalIF":4.2000,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890011/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hepatocellular Carcinoma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/JHC.S490439","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
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Abstract
Purpose: This study aims to investigate liver function changes in hepatocellular carcinoma (HCC) patients treated with transcatheter intra-arterial therapy plus molecular targeted agents and programmed cell death-1 (ligand-1) inhibitors, and evaluate the prognostic significance of the combination of Child-Pugh (CP) class and albumin-bilirubin (ALBI) grade (CP/ALBI).
Methods: This is a retrospective study. A total of 149 patients from 2019 to 2023 in China were included. Changes in CP score, ALBI grade, and CP/ALBI grade at 4-8 weeks, 12-16 weeks, and 20-28 weeks post-treatment was evaluated. Cox regression models identified prognostic factors for overall survival (OS) and progression-free survival (PFS). The discrimination of the scoring systems was determined by concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC).
Results: Among CP-A patients (n = 137), 11.68% (n = 16) progressed to CP-B by 20-28 weeks (p < 0.001). Multivariate analysis identified CP/ALBI grade at 20-28 weeks as an independent prognostic factor for OS (grade 2 vs grade 1, hazard ratio [HR] 3.12, p < 0.001; grade 3 vs grade 1, HR 4.95, p < 0.001) and at 4-8 weeks for PFS (grade 3 vs grade 1, HR 3.26, p = 0.002). The combination of CP/ALBI grade and baseline clinical prognostic factors (Eastern Cooperative Oncology Group Performance Status, Barcelona Clinic Liver Cancer stage, tumor size) demonstrated superior discrimination for OS (C-index: 0.74-0.77; time-dependent AUC: 0.74-0.92). Baseline factors associated with maintaining CP/ALBI grade 1 in CP-A patients included ALBI grade 1 (odds ratio [OR] 3.09, p = 0.030) and aspartate aminotransferase < 40 U/L (OR 3.35, p = 0.017).
Conclusion: A small but notable proportion of HCC patients experienced liver function deterioration within 28-week of combined treatment. Dynamic monitoring of CP/ALBI grade provides valuable prognostic insights for patient stratification.
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