Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma

Table 1 Characteristics of the included patients

Variable	Patients
	n = 1912
Male gender, n (%)	1575 (82.4)
Age (yr, mean ± SD)	57(± 7.2)
Etiology
Hepatitis C	1369 (71.6)
Hepatitis B	468 (24.5)
Other	75 (3.9)
Albumin (g/L, mean ± SD)	31.4(± 4.6)
Bilirubin [µmol/L, median (IQR)]	24.5 (13.9-29.1)
Platelet count (x 109/L, mean ± SD)	96 (± 37.4)
AFP [µg/L, median (IQR)]	43 (10-184.3)
Tumor size [cm, median (IQR)]	5.6 (1.8-8.4)
Solitary tumor, n (%)	369 (19.3)
PVT	345 (18)
Metastasis	148 (7.7)
ECOG grade 0, n (%)	1154 (60.4)
Treatment
Liver resection	67 (3.5)
Liver transplantation	43 (2.3)
Ablative procedures (PEI, RFA and microwave)	249 (13.1)
TACE	1036 (54.1)
Combined treatment (TACE + ablation)	8 (0.4)
Systemic therapy	40 (2.1)
Conservative	469 (24.5)
Overall survival, months (95%CI)	17.9 (12.1-13.8)
Overall deaths, n (%)	1219 (63.8)

AFP: Alpha fetoprotein; PVT: Portal vein thrombosis; TACE: Transarterial chemoembolization; PEI: Percutaneius ethanol injectuion; RFA: Radiofrequency ablation; IQR: Interquartile range.

Table 2 Multivariable Cox regression anaylysis

Variable	Hazard ratio (95%CI)	P-value
Tumour number
Solitary	1
Multiple	1.456 (1.236, 1.750)	<0.01
Log10 tumour size (cm)	3.517 (2.678, 4.567)	<0.001
Baseline log10 AFP	1.302 (1.208, 1.411)	<0.001
Baseline albumin	0.993 (0.966, 0.998)	0.031
Baseline log10 bilirubin	1.581 (1.139, 2.194)	<0.001
Vascular invasion
No	1
Yes	1.612 (1.251, 2.045)	0.001
Aetiology
Hepatitis C virus	1
hepatitis B virus	1.260 (1.020, 1.407)	<0.05
Others	0.914 (0.887, 0.991)	0.043

AFP: Alpha fetoprotein.

Table 3 Distribution and median survival of patients with hepatocellular carcinoma according to the studied staging systems

Staging/grading system	Stage/grade	Percentage of patients	Median survival (mo)	P-value
CTP	A	50.6	19	< 0.001
	B	36.1	11
	C	13.4	3.8
BCLC	0	3.6	25.4	< 0.001
	A	27.5	19.8
	B	26.6	16
	C	28.9	8
	D	13.4	4
TNM	I	19.5	23	< 0.001
	II	36.6	18
	III	35.4	8
	IV	8.5	6
ALBI	1	12	28.6	< 0.001
	2	63.2	14
	3	24.7	5.8
PALBI	1	10.1	34.6	< 0.001
	2	29	27.5
	3	33.9	23.9
	4	27	7.5
ALBI-based BCLC	0	1.5	Undefined	< 0.001
	A	5.9	30.8
	B	67.2	14.2
	C	2.2	11
	D	23.2	5
ALBI-T	0	2.6	42	< 0.001
	1	18.1	28.9
	2	30.4	17
	3	31.1	8
	4	16	5
	5	1.8	3
Modified ALBI-T	0	2.6	42	< 0.001
	1	9.1	28.9
	2	18.5	20
	3	27.9	14
	4	25.5	8
	5	14.6	5
	6	1.8	3

CTP: Child-Turcotte-Pugh score; ALBI: Albumin-bilirubin score; TNM: Tumor-node-metastasis staging system; BCLC: Barcelona Clinic Liver Cancer staging system.

Table 4 AUROC values for all scores at 1 and 3 years in addition to overall survival

Grade	1-yr AUROC	3-yr AUROC	Overall AUROC
TNM	0.639	0.626	0.620
CTP	0.672	0.649	0.643
ALBI	0.741	0.728	0.709
Modified ALBI	0.755	0.732	0.719
PALBI	0.753	0.741	0.734
BCLC	0.758	0.743	0.713
ALBI-based BCLC	0.762	0.751	0.749
ALBI-T	0.822	0.809	0.801
Modified ALBI-T	0.851	0.848	0.848

CTP: Child-Turcotte-Pugh score; ALBI: Albumin-bilirubin score; TNM: Tumor-node-metastasis staging system; BCLC: Barcelona Clinic Liver Cancer staging system.