Research Papers:

Comparison of platelet-albumin-bilirubin (PALBI), albumin-bilirubin (ALBI), and child-pugh (CP) score for predicting of survival in advanced hcc patients receiving radiotherapy (RT)

Connie H.M. Ho, Chi-Leung Chiang _, Francis A.S. Lee, Horace C.W. Choi, Jeffery C.H. Chan, Cynthia S.Y. Yeung, J.J. Huang, Mark K.H. Chan, Oliver Blanck and Frank C.S. Wong

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Oncotarget. 2018; 9:28818-28829. https://doi.org/10.18632/oncotarget.25522

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Connie H.M. Ho1,*, Chi-Leung Chiang1,2,3,*, Francis A.S. Lee1, Horace C.W. Choi2, Jeffery C.H. Chan4, Cynthia S.Y. Yeung1, J.J. Huang1, Mark K.H. Chan5,6, Oliver Blanck5 and Frank C.S. Wong1

1Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong (SAR), China

2Department of Clinical Oncology, University of Hong Kong, Hong Kong (SAR), China

3University of Hong Kong-Shenzhen Hospital, Hong Kong, China

4Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong (SAR), China

5Department of Radiation Oncology, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany

6Department of Radiation Physics, Imperial College NHS Healthcare, Charing Cross Hospital, UK, London

*Co-first author

Correspondence to:

Chi-Leung Chiang, email: [email protected]

Keywords: PALBI; radiotherapy; HCC; survival prediction

Received: March 06, 2018     Accepted: May 12, 2018     Published: June 22, 2018


Purpose: This work evaluated the prognostic performance of Child-Pugh (CP), albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) scores in hepatocellular carcinoma (HCC) patients undergoing radiotherapy (RT).

Results: The study included 174 consecutive patients with 63% at CP A5 (n = 110) and 34% at CP A6 (n = 64). The median ALBI score was −2.39 (range: −3.61 to −1.41) with 34.5% at grade A1 (n = 60) and 65.5% at grade A2 (n = 114). The median PALBI score was −2.39 (range −3.39 to −1.24) with 33.3% at grade 1 (n = 58), 41.4% at grade 2 (n = 72) and 25.3% at grade 3 (n = 44). With a median follow-up of 21.7 months, the median OS of the entire cohort was 22.2 months. OS was significantly associated with the PALBI grade (p = 0.002) and for the ALBI grade (p = 0.00495), but not for the CP score (p = 0.46). The PALBI grade has a significantly higher AUC compared than the ALBI grade or CP scores in predicting OS. The PALBI grade was predictive of CP score decline ≥2 (20% grade 3 vs. 5.3% grade 1/2 p = 0.05) but the ALBI and CP scores were not.

Conclusion: Among CP A HCC patients receiving radiotherapy, the PALBI and ALBI grade maybe a better prognostic tool than the CP score. The role of PALBI in predicting liver toxicity warranted further exploration.

Methods: We retrospectively reviewed HCC patients treated with individualized hypo-fractionated radiotherapy (IHRT) using stereotactic technique from 2006 to 2015. We collected CP, ALBI and PALBI scores prior to treatment and analyzed their correlation with overall survival (OS) and liver toxicity.

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