Hsin-Yeh Chen1, Sheng-Nan Lu1, Jing-Houng Wang1, Chien-Hung Chen1, Chao-Hung Hung1,  Kwong-Ming Kee1, Yi-Hao Yen1, Yuan-Hung Kuo1

1Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung city, Taiwan

Background/Aims: To use albumin-bilirubin (ALBI) grade and up-to-7 (UT7) criteria to assess outcomes of patients with intermediate stage hepatocellular carcinoma (HCC) after transarterial embolization (TAE).

Methods: Between January 2012 and January 2019, newly diagnosed intermediate HCC patients underwent TAE were enrolled and analyzed. The demographics, clinical characteristics and survival were obtained from medical chart reviews.

Results: A total of 359 patients were enrolled and 30.4% of them were within UT7 criteria (UT7(-)). There were 36.5%, 59.3%, and 4.2% of the patients with ALBI grade I, II, and III, respectively. Beyond UT7 (UT7(+)) and ALBI grade II/III were associated with overall mortality in multivariate analysis. Based on ALBI grade I/II/III and UT7 -/+, patients were classified into six groups as ALBI grade I plus UT7(-), II plus UT7(-), III plus UT7(-), I plus UT7(+), II plus UT7(+), and III plus UTI(+). Distributions of median survival were 47.5, 32.9, 15, 34.3, 16.7 and 14.3 months, respectively. Patients with statistically insignificant survivals were further combined. Patients with ALBI grade I plus UT7(-) were reclassified as ALBI-U class I, whereas ALBI grade II plus UT7(-) and I plus UT7(+) were ALBI-U class II, and the others were ALBI-U class III. There were 8.4%, 48.7%, and 42.9% of patients in ALBI-U class I, II, and III, respectively. The 5-year survival rate was 48.8%, 22.5%, and 13.7% in ALBI-U class I, II, and III, respectively (p<0.01).

Conclusion: ALBI-U classification was useful in predicting outcomes of patient with intermediate stage HCC after TAE.

Keywords: Albumin-bilirubin grade, Hepatocellular carcinoma, Intermediate stage, Transarterial embolization, Up-to-7