Prognosis of Patients with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization(MC-hccAI 001): Development and Validation of the ALFP Score

• Published in: Journal of hepatocellular carcinoma Vol. 10; pp. 1341 - 1351
• Main Authors: Gong, Baocuo, Wang, Xuewen, Guo, Wanting, Yang, Hongyi, Shi, Yanhong, Chen, Yaying, Gao, Simiao, Chen, Jialin, Liu, Lifang, Lu, Linbin, Chen, Xiong
• Format: Journal Article
• Language: English
• Published: Dove 01.01.2023; Dove Medical Press
• Subjects: albumin-bilirubin grade；α-fetoprotein； prothrombin time； transarterial chemoembolization； hepatocellular carcinoma; Original Research
• ISSN: 2253-5969; 2253-5969
• DOI: 10.2147/JHC.S415770

BackgroundTransarterial chemoembolization (TACE) is the recommended first-line treatment for intermediate-stage Hepatocellular carcinoma (HCC) patients. However, predicting the survival of HCC patients receiving TACE remains challenging. MethodsIn this retrospective study, we analyzed a total of 1805 HCC patients who received TACE. The patients were randomly divided into a training set (n = 1264) and a validation set (n = 541). We examined various prognostic factors within the training set and developed a simple ALFP (ALBI grade, AFP, and Prothrombin time) score, which was subsequently validated using the independent validation set. ResultsOur multivariate analysis revealed that baseline ALBI grade 2 or 3, AFP ≥ 100 ng/mL, and PT > 13.1 s were independent unfavorable prognostic factors for HCC patients receiving TACE (p < 0.05). Based on these findings, we constructed the ALFP score, which assigns 1 point each for ALBI grade 2 or 3, AFP ≥ 100 ng/mL, and PT > 13.1 s. The score has a range of 0 to 3, and higher scores are associated with poorer outcomes. The median overall survival (OS) varied significantly among different ALFP score groups, both in the training set and the validation set (p < 0.001). We further examined the ALFP score in subgroups based on tumor diameter and the number of intrahepatic lesions. In each subgroup, higher ALFP scores were consistently associated with lower OS (p < 0.05). ConclusionOur study confirms the prognostic value of the ALFP score in predicting the survival of HCC patients undergoing TACE. The score incorporates easily obtainable baseline parameters and provides a simple and practical tool for risk stratification and treatment decision-making in HCC patients.