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Predictive Outcomes Using Child-Turcotte-Pugh and Albumin-Bilirubin Scores in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

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Abstract

Introduction

We assessed the ability of the Child-Turcotte-Pugh score and the albumin-bilirubin grade to predict the outcomes of hepatocellular carcinoma (HCC) in patients treated with transarterial chemoembolization.

Methods

We retrospectively assessed 158 patients with HCC who underwent transarterial chemoembolization. The ability of the Child-Turcotte-Pugh score and the albumin-bilirubin grade to predict patient survival was assessed using the Kaplan–Meier method. The Cox proportional hazards model was used to evaluate survival-predictive variables and the relationship between the obtained score and overall survival.

Results

Child-Turcotte-Pugh A (n = 102 (64.6%)) patients showed better overall survival than Child-Turcotte-Pugh B (n = 56 (35.4%)) patients (log-rank P = 0.017), while no significant difference in the overall survival between albumin-bilirubin ≤ 1 (n = 37 (23.4%)) and albumin-bilirubin > 1 (n = 121 (76.6%)) was detected (log-rank P = 0.140). Multivariate analysis identified alcoholic liver disease (P = 0.029), tumor size > 5 cm (P = 0.004), and serum alpha-fetoprotein > 200 ng/mL (P < 0.001) as independent predictive factors of mortality risk. A higher Child-Turcotte-Pugh score was positively associated with decreased overall survival (P = 0.031); however, a higher albumin-bilirubin grade showed marginally significant association (P = 0.088).

Conclusions

The Child-Turcotte-Pugh score precisely categorized the outcomes of HCC in patients undergoing transarterial chemoembolization, and cirrhotic patients with Child-Turcotte-Pugh A will have a better overall survival than those with Child-Turcotte-Pugh B, regardless of HCC status. These results suggest that the Child-Turcotte-Pugh classification system is a more powerful tool to predict patient outcomes than the albumin-bilirubin grading system.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110, Thailand

    Keerati Akarapatima, Arunchai Chang & Attapon Rattanasupar

  2. Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand

    Tanaporn Prateepchaiboon & Nuttanit Pungpipattrakul

  3. Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Songkhla, Thailand

    Apiradee Songjamrat & Songklod Pakdeejit

  4. NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkhla University, Songkhla, Thailand

    Teerha Piratvisuth

Authors
  1. Keerati Akarapatima
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  2. Arunchai Chang
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  4. Nuttanit Pungpipattrakul
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  5. Apiradee Songjamrat
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Contributions

Conception: Keerati Akarapatima, Arunchai Chang; design: A.C., Attapon Rattanasupar; data acquisition: Tanaporn Prateepchaiboon, Nuttanit Pungpipattrakul, Apiradee Songjamrat, Songklod Pakdeejit; data analysis: K.A., A.C.; interpreted the results: A.C., Teerha Piratvisuth; drafting the manuscript: K.A., A.C., Tanaporn Prateepchaiboon, N.P., A.S., S.P.; critically revision the manuscript: A.C., A.R., Teerha Piratvisuth; all the authors read and approved the final manuscript.

Corresponding author

Correspondence to Arunchai Chang.

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Ethics Approval and Consent to Participate

The study protocol was approved by the Ethics Committee of Hatyai Hospital Institutional Review Board (number HYHECO047-64–01), and the requirement for informed consent was waived due to the retrospective nature of the study.

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The authors have no competing interests.

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Akarapatima, K., Chang, A., Prateepchaiboon, T. et al. Predictive Outcomes Using Child-Turcotte-Pugh and Albumin-Bilirubin Scores in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. J Gastrointest Canc 53, 1006–1013 (2022). https://doi.org/10.1007/s12029-021-00743-6

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