Albumin - bilirubin (ALBI) versus Child-Turcotte-Pugh (CTP) in prognosis of HCC after stereotactic body radiation therapy

BackgroundChild-Turcotte-Pugh (CTP) score extensively used to assess hepatic function, predicting postoperative outcome of hepatocellular carcinoma (HCC) patients. Lately, the albumin-bilirubin (ALBI) grade has been identified to be a predictor of overall survival of HCC patients. In this investigation, we compared the pre-SBRT ALBI and CTP scores with the prognosis of patients with HCC.MethodsThis cohort study included 594 HCC patients who treated with SBRT. Overall survival (OS) rates were measured from treatment date to death date or last follow-up. We compared ALBI score with the CTP score in predicting long-term survival.ResultsThe average follow-up time was 21months (1 to 82months). The CTP and ALBI ratings have discriminatory for long-term survival across the groups. CTP class was significantly related to OS, with a median OS of 29.9months in CTP-A, 11.5 in CTP-B (P<0.0001). ALBI grade is also significantly related to OS, with a median OS of 53.0months in ALBI-1, 19.5months in ALBI-2, and 6.5months in ALBI-3(P<0.0001). Within CTP-A class, CTP score-A5/A6 and ALBI grade has a similar predictive power (all P<0.001). However, both CTP score and ALBI grade have no predictive power in CTPB7 class (all P>0.05).ConclusionsTo assess liver dysfunction in HCC patients before SBRT, traditional CTP classification is a necessary but imperfect tool for assessing HCC liver injury. The ALBI score is a more objective, discriminatory and evidence-based approach in CTP-A groups, and need to be validated in CTPB7 class.