Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2019; 11(6): 542-552
Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.542
Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma
Omar Elshaarawy, Alzhraa Alkhatib, Mostafa Elhelbawy, Asmaa Gomaa, Naglaa Allam, Ayman Alsebaey, Eman Rewisha, Imam Waked
Omar Elshaarawy, Alzhraa Alkhatib, Mostafa Elhelbawy, Asmaa Gomaa, Naglaa Allam, Ayman Alsebaey, Eman Rewisha, Imam Waked, Departemnt of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Menoufia 3511, Egypt
Author contributions: All authors contributed to the writing of the manuscript; Elshaarawy O, Alkhatib A and Elhelbawy M collected the data; Elshaarawy O, Gomaa A, Allam N, Rewisha E and Waked I revised and edited the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Liver Institute, Menoufia University.
Informed consent statement: Informed written consent was granted from all patients.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article are reported.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Omar Elshaarawy, MBChB, MSc, Attending Doctor, Departemnt of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Meleg Road, Menoufia 3511, Egypt. oelshaarawy@liver.menofia.edu.eg
Telephone: +20-10-06603345
Received: March 12, 2019
Peer-review started: March 12, 2019
First decision: April 10, 2019
Revised: May 16, 2019
Accepted: June 17, 2019
Article in press: June 17, 2019
Published online: June 27, 2019
Processing time: 108 Days and 20.5 Hours
ARTICLE HIGHLIGHTS
Research background

It has been an urge to find a proper staging system for patients with hepatocellular carcinoma (HCC). The significance of this study is owed to comparing on a large scale a wide selection of scoring systems that included established [Child-Turcotte-Pugh (CTP), TNM and Barcelona Clinic Liver Cancer (BCLC)] and novel scoring systems (albumin-bilirubin (ALBI), plateltet-albumin–bilirubin (PALBI), ALBI-BCLC, ALBI-T and modified albumin-bilirubin-TNM (mALBI-T)].

Research objectives

Linear predictive equations based scoring systems (such as ALBI and PALBI) offer better performance than those based on predetermined cut-off points (CTP, TNM and BCLC). The best scoring system would be a linear function that incorporates liver function paramters and other tumor specific paramters such as alpha fetoprotein (AFP), tumor size and number.

Researh methods

We applied the tested scoring systems on our retrospective cohort and compared their performance using survival curves and AUROCS to predict survival in addition to patient stratification according to different scores.

Research results

Our findings proved that the modified version of ALBI-T score offered better stratification than the original score and is a better prognostic tool. It remains to be explored whether treatment modality specific scores would result in better performance than general scores or not and whether we need such specific scores or not.

Research conclusions

This study offers a validation of the mALBI-T score in a large scale Egyptian cohort. mALBI-T performs better than the other investigated scoring systems such as ALBI and BCLC.

Research perspectives

The best model for HCC patients should assess liver function, tumor number, size and other tumor specific paramters such as AFP. We suggest developing scores that include treatment response such as mRECIST criteria or recurrence status. Linear equations based scores are more precise and future scores should abandon old techniques that use predetermined points.