Value of Child-Pugh score versus albumin-bilirubin grade in predicting the prognosis of unresectable hepatocellular carcinoma treated by transarterial chemoembolization

Objective To investigate the ability of Child-Pugh score versus albumin-bilirubin(ALBI) grade in predicting the overall survival of hepatocellular carcinoma(HCC) patients with good liver function undergoing transarterial chemoembolization(TACE). Methods A retrospective analysis was performed for the clinical data of 185 patients with unresectable HCC who underwent TACE in Xijing Hospital of Digestive Diseases,Air Force Medical University,from January 2010 to December 2014,including epidemiological data(age,sex,and etiology),laboratory parameters(routine blood test results,hepatic and renal function,and coagulation function),and imaging data(tumor size and number). Overall survival time was calculated,and Child-Pugh score and ALBI grade were determined based on baseline data and laboratory results. Risk stratification was performed based on Child-Pugh score and ALBI grade,the Kaplan-Meier method was used to plot survival curves,and the log-rank test was used to compare overall survival. The Cox regression model was used to analyze risk factors.The time-dependent receiver operating characteristic(ROC) curve and C-index were used to compare the ability of Child-Pugh score and ALBI grade in predicting survival. Results According to Child-Pugh score,the patients with 5 points had a median survival time of25. 3 months(95% confidence interval [CI]: 20. 1-30. 5 months),and those with 6 points had a median survival time of 8. 6 months(95% CI: 7. 5-16. 9 months); there was a significant difference between them(P = 0. 002). According to ALBI grade,the patients with ALBI grade 1 had a median survival time of 29. 1 months(95% CI: 25. 9-32. 3 months),and those with ALBI grade 2 had a median survival time of 15. 1 months(95% CI: 12. 7-17. 6 months); there was a significant difference in survival tine between them(P < 0. 001).ECOG score,tumor size,number of tumors,alpha-fetoprotein,aspartate aminotransferase,albumin,total bilirubin,Child-Pugh score,and ALBI grade were associated with survival(all P < 0. 05). The three analytical models showed that after the adjustment for hazard ratio(HR) in the multivariate analysis,albumin(HR = 0. 93,95% CI: 0. 90-0. 97,P < 0. 001),bilirubin(HR = 1. 04,95% CI: 1. 02-1. 06,P < 0. 001),Child-Pugh score(HR = 1. 75,95% CI: 1. 18-2. 59,P = 0. 005),and ALBI grade(HR = 1. 82,95% CI: 1. 29-2. 59,P = 0. 001) independently predicted the overall survival of the patients. The time-dependent ROC curve analysis showed that the ability of Child-Pugh score in predicting survival tended to decrease over the time of observation,while the ability of ALBI grade remained relatively stable. These two systems had a similar ability in predicting survival within 12 months,while ALBI grade had a better ability than Child-Pugh score thereafter. Child-Pugh score had a slightly lower C-index than ALBI grade [0. 57(95% CI: 0. 53-0. 60) vs 0. 63(95% CI: 0. 57-0. 68) ]. Conclusion Both ALBI grade and Child-Pugh score can be used for prognostic stratification of HCC patients undergoing TACE alone,but ALBI grade has a better long-term predictive ability than Child-Pugh score.