Prognosticating Survival in Hepatocellular Carcinoma with Elevated Baseline Alpha-fetoprotein Treated with Radioembolization Using a Novel Laboratory Scoring System

Initial Development and Validation

Rehan Ali, Yihe Yang, Mark Antkowiak, Ahmed Gabr, Ronald Mora, Nadine Abouchaleh, Ali Al Asadi, Laura M Kulik, Daniel R Ganger, Michael Messod Abecassis, Nitin Kataraya, Mary Frances Mulcahy, Al B Benson III, Devalingam Mahalingam, Bartley Thornburg, Samdeep K Mouli, Robert J Lewandowski, Riad Salem, Ahsun Riaz*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Aims: To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with radioembolization and develop/validate a scoring system. Methods: With IRB approval, we included all patients with baseline alpha-fetoprotein (AFP) > 100 ng/dL from our prospectively acquired HCC radioembolization database. Neutrophil–lymphocyte ratio, albumin–bilirubin (ALBI), and AFP were measured at baseline and at 1-, 3-, and 6-month post-radioembolization Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Baseline Imaging, Laboratory, and Combination scoring systems were developed. Developing/validating groups were created to investigate/validate the score’s OS predictability. Time-dependent receiver operating characteristics (ROC) were evaluated. Patients were stratified into groups I, II, and III by using 25th and 75th percentile cutoffs according to change in Laboratory Score from baseline. Results: 345/401 (86%), 238/401 (59%), and 167/401 (42%) patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI and AFP were significant OS prognosticators at all Landmarks. The Laboratory Score [ALBI + (0.3 × LnAFP)] was developed/internally validated to predict OS from these Landmarks. Areas under the curve of time-dependent ROCs of the Baseline Imaging vs. Laboratory scores in predicting patient OS post 3 and 6 months Landmarks were 0.56 versus 0.82 and 0.57 versus 0.77, respectively. OS differences in groups I, II, and III according to change in Laboratory Score from baseline were significant (p < 0.001). Conclusions: Post-radioembolization AFP and ALBI scores were significant OS prognosticators. A decrease in post-therapeutic Laboratory Score, which combines AFP and ALBI, correlates with an improved OS.

Original languageEnglish (US)
JournalCardiovascular and Interventional Radiology
DOIs
StatePublished - Jan 1 2019

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alpha-Fetoproteins
Hepatocellular Carcinoma
Survival
Research Ethics Committees
ROC Curve
Area Under Curve
Multivariate Analysis
Databases

Keywords

  • Alpha-fetoprotein (AFP)
  • HCC survival
  • Hepatocellular carcinoma (HCC)
  • Laboratory prognosticators for HCC survival
  • Radioembolization
  • TARE

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{5f867d435ccd413b960e77ff52b4ce24,
title = "Prognosticating Survival in Hepatocellular Carcinoma with Elevated Baseline Alpha-fetoprotein Treated with Radioembolization Using a Novel Laboratory Scoring System: Initial Development and Validation",
abstract = "Aims: To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with radioembolization and develop/validate a scoring system. Methods: With IRB approval, we included all patients with baseline alpha-fetoprotein (AFP) > 100 ng/dL from our prospectively acquired HCC radioembolization database. Neutrophil–lymphocyte ratio, albumin–bilirubin (ALBI), and AFP were measured at baseline and at 1-, 3-, and 6-month post-radioembolization Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Baseline Imaging, Laboratory, and Combination scoring systems were developed. Developing/validating groups were created to investigate/validate the score’s OS predictability. Time-dependent receiver operating characteristics (ROC) were evaluated. Patients were stratified into groups I, II, and III by using 25th and 75th percentile cutoffs according to change in Laboratory Score from baseline. Results: 345/401 (86{\%}), 238/401 (59{\%}), and 167/401 (42{\%}) patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI and AFP were significant OS prognosticators at all Landmarks. The Laboratory Score [ALBI + (0.3 × LnAFP)] was developed/internally validated to predict OS from these Landmarks. Areas under the curve of time-dependent ROCs of the Baseline Imaging vs. Laboratory scores in predicting patient OS post 3 and 6 months Landmarks were 0.56 versus 0.82 and 0.57 versus 0.77, respectively. OS differences in groups I, II, and III according to change in Laboratory Score from baseline were significant (p < 0.001). Conclusions: Post-radioembolization AFP and ALBI scores were significant OS prognosticators. A decrease in post-therapeutic Laboratory Score, which combines AFP and ALBI, correlates with an improved OS.",
keywords = "Alpha-fetoprotein (AFP), HCC survival, Hepatocellular carcinoma (HCC), Laboratory prognosticators for HCC survival, Radioembolization, TARE",
author = "Rehan Ali and Yihe Yang and Mark Antkowiak and Ahmed Gabr and Ronald Mora and Nadine Abouchaleh and {Al Asadi}, Ali and Kulik, {Laura M} and Ganger, {Daniel R} and Abecassis, {Michael Messod} and Nitin Kataraya and Mulcahy, {Mary Frances} and {Benson III}, {Al B} and Devalingam Mahalingam and Bartley Thornburg and Mouli, {Samdeep K} and Lewandowski, {Robert J} and Riad Salem and Ahsun Riaz",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s00270-019-02191-z",
language = "English (US)",
journal = "CardioVascular and Interventional Radiology",
issn = "7415-5101",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Prognosticating Survival in Hepatocellular Carcinoma with Elevated Baseline Alpha-fetoprotein Treated with Radioembolization Using a Novel Laboratory Scoring System

T2 - Initial Development and Validation

AU - Ali, Rehan

AU - Yang, Yihe

AU - Antkowiak, Mark

AU - Gabr, Ahmed

AU - Mora, Ronald

AU - Abouchaleh, Nadine

AU - Al Asadi, Ali

AU - Kulik, Laura M

AU - Ganger, Daniel R

AU - Abecassis, Michael Messod

AU - Kataraya, Nitin

AU - Mulcahy, Mary Frances

AU - Benson III, Al B

AU - Mahalingam, Devalingam

AU - Thornburg, Bartley

AU - Mouli, Samdeep K

AU - Lewandowski, Robert J

AU - Salem, Riad

AU - Riaz, Ahsun

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aims: To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with radioembolization and develop/validate a scoring system. Methods: With IRB approval, we included all patients with baseline alpha-fetoprotein (AFP) > 100 ng/dL from our prospectively acquired HCC radioembolization database. Neutrophil–lymphocyte ratio, albumin–bilirubin (ALBI), and AFP were measured at baseline and at 1-, 3-, and 6-month post-radioembolization Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Baseline Imaging, Laboratory, and Combination scoring systems were developed. Developing/validating groups were created to investigate/validate the score’s OS predictability. Time-dependent receiver operating characteristics (ROC) were evaluated. Patients were stratified into groups I, II, and III by using 25th and 75th percentile cutoffs according to change in Laboratory Score from baseline. Results: 345/401 (86%), 238/401 (59%), and 167/401 (42%) patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI and AFP were significant OS prognosticators at all Landmarks. The Laboratory Score [ALBI + (0.3 × LnAFP)] was developed/internally validated to predict OS from these Landmarks. Areas under the curve of time-dependent ROCs of the Baseline Imaging vs. Laboratory scores in predicting patient OS post 3 and 6 months Landmarks were 0.56 versus 0.82 and 0.57 versus 0.77, respectively. OS differences in groups I, II, and III according to change in Laboratory Score from baseline were significant (p < 0.001). Conclusions: Post-radioembolization AFP and ALBI scores were significant OS prognosticators. A decrease in post-therapeutic Laboratory Score, which combines AFP and ALBI, correlates with an improved OS.

AB - Aims: To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with radioembolization and develop/validate a scoring system. Methods: With IRB approval, we included all patients with baseline alpha-fetoprotein (AFP) > 100 ng/dL from our prospectively acquired HCC radioembolization database. Neutrophil–lymphocyte ratio, albumin–bilirubin (ALBI), and AFP were measured at baseline and at 1-, 3-, and 6-month post-radioembolization Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Baseline Imaging, Laboratory, and Combination scoring systems were developed. Developing/validating groups were created to investigate/validate the score’s OS predictability. Time-dependent receiver operating characteristics (ROC) were evaluated. Patients were stratified into groups I, II, and III by using 25th and 75th percentile cutoffs according to change in Laboratory Score from baseline. Results: 345/401 (86%), 238/401 (59%), and 167/401 (42%) patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI and AFP were significant OS prognosticators at all Landmarks. The Laboratory Score [ALBI + (0.3 × LnAFP)] was developed/internally validated to predict OS from these Landmarks. Areas under the curve of time-dependent ROCs of the Baseline Imaging vs. Laboratory scores in predicting patient OS post 3 and 6 months Landmarks were 0.56 versus 0.82 and 0.57 versus 0.77, respectively. OS differences in groups I, II, and III according to change in Laboratory Score from baseline were significant (p < 0.001). Conclusions: Post-radioembolization AFP and ALBI scores were significant OS prognosticators. A decrease in post-therapeutic Laboratory Score, which combines AFP and ALBI, correlates with an improved OS.

KW - Alpha-fetoprotein (AFP)

KW - HCC survival

KW - Hepatocellular carcinoma (HCC)

KW - Laboratory prognosticators for HCC survival

KW - Radioembolization

KW - TARE

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U2 - 10.1007/s00270-019-02191-z

DO - 10.1007/s00270-019-02191-z

M3 - Article

JO - CardioVascular and Interventional Radiology

JF - CardioVascular and Interventional Radiology

SN - 7415-5101

ER -