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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy
Huttakan Navadurong, Thaninee Prasoppokakorn, Nanicha Siriwong, Chonlada Phathong, Nattaya Teeyapun, Suebpong Tanasanvimon, Kessarin Thanapirom, Piyawat Komolmit, Pisit Tangkijvanich, Sombat Treeprasertsuk, Roongruedee Chaiteerakij
Huttakan Navadurong, Thaninee Prasoppokakorn, Nanicha Siriwong, Chonlada Phathong, Kessarin Thanapirom, Piyawat Komolmit, Sombat Treeprasertsuk, Roongruedee Chaiteerakij, Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Huttakan Navadurong, Thaninee Prasoppokakorn, Nanicha Siriwong, Chonlada Phathong, Nattaya Teeyapun, Suebpong Tanasanvimon, Kessarin Thanapirom, Piyawat Komolmit, Sombat Treeprasertsuk, Roongruedee Chaiteerakij, The Thai Red Cross Society, Bangkok 10330, Thailand
Nattaya Teeyapun, Suebpong Tanasanvimon, Department of Medicine, Division of Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Pisit Tangkijvanich, Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Roongruedee Chaiteerakij, Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Navadurong H and Chaiteerakij R designed the study; Navadurong H, Prasoppokakorn T, Siriwong N, and Phathong C contributed to data acquisition; Teeyapun N, Tanasanvimon S, Thanapirom K, Komolmit P, Tangkijvanich T, and Treeprasertsuk S recruited and managed the patients; Navadurong H, Prasoppokakorn T, and Phathong C analyzed and interpreted the data; Navadurong H, and Prasoppokakorn T drafted the manuscript; Prasoppokakorn T and Chaiteerakij R revised the manuscripts critically for important intellectual content; All the authors read and approved the final manuscript.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (No.892/63).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article 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 NonCommercial (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:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Roongruedee Chaiteerakij, MD, PhD, Associate Professor, Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Khwaeng Pathum Wan, Khet Pathum Wan, Bangkok 10330, Thailand. roon.chaiteerakij@chula.md
Received: March 12, 2023
Peer-review started: March 12, 2023
First decision: April 19, 2023
Revised: July 1, 2023
Accepted: August 15, 2023
Article in press: August 15, 2023
Published online: October 15, 2023
BACKGROUND
Modified albumin-bilirubin (mALBI) grade has been established as a survival determinant in hepatocellular carcinoma (HCC) patients who receive locoregional and targeted therapies.
AIM
To investigate whether mALBI could predict survival in unresectable HCC (uHCC) patients who were treated with atezolizumab plus bevacizumab (AB).
METHODS
A single-center, retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June 2023. An association between mALBI and patient survival was determined using Cox proportional hazards analysis.
RESULTS
Of the 83 patients, 67 patients (80.7%) were male with the mean age of 60.6 years. Among them, 22 patients (26.5%) were classified as Barcelona Clinic Liver Cancer B, and 61 patients (73.5%) were classified as Barcelona Clinic Liver Cancer C. Cirrhosis was present in 76 patients (91.6%), with 58 patients classified as Child-Turcotte-Pugh (CTP) A and 18 as CTP B. The median overall survival (OS) and progression-free survival were 13.0 mo [95% confidence interval (CI): 5.2-20.8] and 9.0 mo (95%CI: 5.0-13.0), respectively. The patients were divided into two groups based on mALBI grades: 42 patients (50.6%) in the mALBI 1 + 2a group; and 41 patients (49.4%) in the mALBI 2b + 3 group. During the median follow-up period of 7.0 mo, the mALBI 1 + 2a group exhibited significantly better survival compared to the mALBI 2b + 3 group, with a median OS that was not reached vs 3.0 mo (95%CI: 0.1-6.0, P < 0.001). In a subgroup of patients with CTP A, the mALBI 1 + 2a group also showed significantly longer survival compared to the mALBI 2b + 3 group, with a median OS that was not reached vs 6.0 mo (95%CI: 3.4-8.6, P < 0.001). In the multivariate analysis, both CTP class and mALBI grade were independently associated with survival, with adjusted hazard ratios (95%CI) of 2.63 (1.19-5.78, P = 0.020) and 3.90 (1.71-8.90, P = 0.001), respectively.
CONCLUSION
mALBI grades can determine survival of uHCC patients receiving AB treatment, particularly those who have mildly impaired liver function. This highlights the importance of assessing mALBI before initiating AB treatment to optimize therapeutic efficacy in clinical practice.
Core Tip: The modified albumin-bilirubin (mALBI) grade has been shown to determine survival in hepatocellular carcinoma patients receiving locoregional and targeted therapies. This study demonstrated that mALBI can also predict survival in unresectable hepatocellular carcinoma patients receiving atezolizumab plus bevacizumab. To improve the therapeutic outcome of atezolizumab plus bevacizumab treatment in clinical practice, mALBI assessment before initiating treatment can help in identifying suitable candidates for immunotherapy.
