J. Sanchez-Garcia1, F. Lopez-Verdugo1, R. Riegler2, M. Jepperson3, A. Gagnon1,4, D. Alonso1, S. Fujita1,4,5, M. I. Rodriguez-Davalos1,5, R. Thota6, G. Cannon7, J. Krong8, S. Dow8, R. Gilroy1, M. Kringlen3, I. R. Zendejas-Ruiz1,4 1Intermountain Medical Center,Liver Transplant Service,Salt Lake City, UT, USA 2Intermountain Medical Center,Imaging Research Service,Salt Lake City, UT, USA 3Intermountain Medical Center,Interventional Radiology Service,Salt Lake City, UT, USA 4Canyon Surgical Associates,Hepatobiliary And Liver Transplantation Service,Salt Lake City, UT, USA 5Primary Children’s Hospital,Liver Transplant Service,Salt Lake City, UT, USA 6Intermountain Medical Center,Oncology/Hematology Service,Salt Lake City, UT, USA 7Intermountain Medical Center,Radiation Oncology Service,Salt Lake City, UT, USA 8Intermountain Medical Center,Transplant Research Department,Salt Lake City, UT, USA
Introduction: Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death in the world. It is widely perceived that survival depends on tumor stage. Recently, platelet-albumin-bilirubin (PALBI) score was reported to be superior to Child-Pugh classification and albumin-bilirubin (ALBI) score in terms of mortality prediction. Trans-arterial radioembolization (TARE) is a minimally invasive therapy used as bridge for liver transplantation or resection. The aim of this study is to assess pre-TARE PALBI score prognostic performance among other liver function scores and/or inflammatory markers.
Methods: We retrospectively assessed all patients with HCC that underwent TARE between February 2008 and January 2020. Demographic characteristics; and laboratory values were collected to calculate Model for End-Stage Liver Disease (MELD), ALBI, PALBI, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) within six months before TARE. Results are presented as proportions and median (IQR). Continuous variables were transformed into qualitative or ordinal variables according to maximally selected rank statistics of the given parameter. Multivariate Cox regression analysis was performed to identify risk factors for overall survival.
Results: A total of 212 patients were included, 72% were males and the median age was 64 (57-69). TARE was used as intention-to-bridge in 60% of cases. Of all cases, 82% were treatment-naïve. The median tumor size was 3.7 (2.6-6.2) cm with 57% having unifocal lesions. The median pretreatment values were: neutrophils (NE) 2.8 (2.1-3.9) x 103/mL, MELD 9 (7-11), ALBI -2.09 (-2.45 to -1.72), PALBI -2.23 (-2.45 to -2.01), PLR 100 (66.2-141.4), and NLR 2.61 (1.85-4.36). Destination therapy (OR=3.6: 95%CI 2.5-5.3; p<0.0001), pretreatment with chemotherapy alone (OR=7: 95%CI 3.3-15; p= <0.0001), size (OR=1.1 per cm increment: 95%CI 1.1-1.2; p<0.0001), NE (OR=1.2: 95%CI 1.1-1.3; p<0.0001), and PALBI (OR=1.7: 95%CI 1-2.8; p=0.035) were significant in univariate Cox regression. MELD and ALBI score were not significant. NE, PALBI and tumor size were transformed into binomial variables. Optimal cutoffs for NE and PALBI were calculated at 2.5 and -2.33, respectively. Size cutoff was set at 3cm to follow our institutional algorithm. Multivariate Cox regression showed a C-index of 73 with a global p-value <0.0001 (Figure 1).
Conclusion: To our knowledge, this is the first report of PALBI as prognostic factor in patients undergoing TARE. Interestingly, the multivariate cox regression showed us other important factors available at the time of medical decision-making. These results can improve our patient selection for TARE.
