Value of modified albumin-bilirubin grade in predicting the prognosis of patients with Child-Pugh class A unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization combined with immunotherapy and anti-angiogenic drugs
Objective To investigate the ability of the modified albumin-bilirubin(mALBI)grade in predicting the prognosis of patients with Child-Pugh A unresectable hepatocellular carcinoma(uHCC)after transcatheter arterial chemoembolization(TACE)combined with immunotherapy and anti-angiogenic drugs(hereafter referred to as targeted immunotherapy).Methods A retrospective analysis was performed for the data of 76 patients with Child-Pugh A uHCC who met the inclusion criteria and underwent TACE combined with targeted immunotherapy in The First Affiliated Hospital of Soochow University from January 2020 to January 2023,and according to the mALBI grade,they were divided into mALBI 1/2a group with 38 patients and mALBI 2b group with 38 patients.The primary endpoint was overall survival(OS),and the secondary endpoints were progression-free survival(PFS),objective response rate(ORR),and disease control rate(DCR).Evaluation criteria included complete remission,partial remission,stable disease,and progressive disease.The independent-samples t test was used for comparison of normally distributed continuous data between groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical variables between two groups.The Kaplan-Meier method was used to plot survival curves,and the Log-rank test was used for comparison of median OS(mOS)and median PFS(mPFS)between groups.The univariate and multivariate Cox proportional hazards models were used to analyze the influencing factors for prognosis.Results There were significant differences in albumin and tumor burden between the two groups(both P<0.05).The 76 patients had an mOS of 25.2 months(95%confidence interval[CI]:18.4-32.0),an mPFS of 9.4 months(95%CI:7.1-11.7),an ORR of 63.2%,and a DCR of 82.9%.The mOS was 30.1 months(95%CI:19.8-40.4)in the mALBI 1/2a group and 19.5 months(95%CI:7.1-31.9)in the mALBI 2b group,and there was a significant difference in mOS between the two groups(χ2=4.490,P=0.034).The mALBI 1/2a group had an mPFS of 10.2 months(95%CI:8.4-12.0),an ORR of 71.1%,and a DCR of 86.8%,while the mALBI 2b group had an mPFS of 7.6 months(95%CI:4.6-10.6),an ORR of 55.3%,and a DCR of 78.9%;there were no significant differences in mPFS,ORR,and DCR between the two groups(all P>0.05).ECOG status,tumor burden,mALBI grade,portal vein invasion,and extrahepatic metastasis were independent risk factors for mOS in patients undergoing TACE combined with targeted immunotherapy(all P<0.05).There were no treatment-related deaths.Conclusion The mALBI grade has a good value in predicting the survival of patients with Child-Pugh A uHCC undergoing TACE combined with targeted immunotherapy.
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