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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
ARTICLE HIGHLIGHTS
Research background
Modified albumin-bilirubin (mALBI) grade has been established as a survival determinant in hepatocellular carcinoma (HCC) patients who receive locoregional and targeted therapies.
Research motivation
The predictive value of mALBI grade for predicting outcomes of HCC patients receiving atezolizumab plus bevacizumab (AB) treatment has yet to be fully investigated.
Research objectives
To assess whether mALBI could predict survival in unresectable HCC patients who were treated with AB.
Research methods
A single-center, retrospective cohort study enrolled unresectable HCC 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.
Research results
Of the 83 patients, the median overall survival (OS) was 13.0 mo [95% confidence interval (CI): 5.2-20.8]. The median progression-free survival was 9.0 mo (95%CI: 5.0-13.0). 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. 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 Child-Turcotte-Pugh (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).
Research conclusions
Our study demonstrated that mALBI grades are a more reliable prognostic factor than CTP classification, particularly for distinguishing outcomes of patients within the CTP A class.
Research perspectives
The assessment of liver functional reserve using mALBI before initiating AB treatment can assist in identifying appropriate candidates for this therapy.
