The platelet-albumin-bilirubin score in predicting hepatic failure after TACE for non-small hepatocellular carcinoma.

Abstract

Objective: To evaluate the predictive value of the platelet-albumin-bilirubin (PALBI) score for hepatic failure after transarterial chemoembolization (TACE) in patients with non-small hepatocellular carcinoma (HCC) (tumor diameter > 5 cm).

Methods: A retrospective study included 577 non-small HCC patients who underwent TACE between January 2018 and December 2024. Patients were stratified by PALBI grade (Grade 1: ≤-2.53; Grade 2: > -2.53 to ≤-2.09; Grade 3: > -2.09). Hepatic failure was defined and graded (A-C) according to ISGLS criteria. The predictive efficacy of PALBI, ALBI, and Child-Pugh scores was compared using ROC curves.

Results: Hepatic failure occurred in 28.2% (163/577) of patients (Grade A: 22.0%; B: 4.6%; C: 1.5%). Hepatic failure incidence significantly increased with PALBI grade: 10.31% (Grade 1), 27.83% (Grade 2), and 78.95% (Grade 3) (p < 0.001). PALBI demonstrated superior predictive efficacy (AUC = 0.746) compared to ALBI (AUC = 0.702, p = 0.004) and Child-Pugh (AUC = 0.706, p = 0.075). Multivariate analysis identified ascites, AST, and total bilirubin as independent risk factors for hepatic failure (p < 0.05).

Conclusion: The PALBI score is an effective tool for predicting hepatic failure after TACE in non-small HCC patients. PALBI Grade 3 indicates high risk (78.95%), suggesting preoperative liver protection therapy before TACE. PALBI outperforms ALBI and Child-Pugh scores in risk stratification.