Preoperative ALBI,PNI,and MLR For The Prognostic Evaluation Of Hepatocellular Carcinoma Patients After Hepatic Artery Chemoembolization

Objectives:Preoperative albumin-bilirubin(ALBI)score,prognostic nutrition index(PNI),and monocyte-to-lymphocyte ratio(MLR)have predictive value for the prognosis of hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE)in liver cell cancer,providing new clinical reference for TACE treatment of liver cell cancer.Collect basic information of patients diagnosed with hepatocellular carcinoma(HCC)and treated with transarterial chemoembolization(TACE)at the First Affiliated Hospital of Dali University from 2015 to 2022,aiming to retrospectively study the clinical features,laboratory indicators,and imaging characteristics of TACE treatment for HCC during this period.A total of 90 valid cases were collected,and the overall survival(OS)within one year from the initial surgery date to patient death was calculated for all fully followed-up cases.All data were statistically analyzed using SPSS 25.0.ROC curves of ALBI,PNI,and MLR were plotted for patients,and the optimal cutoff values of ALBI,PNI,and MLR were calculated.They were divided into high and low groups according to their ALBI,PNI,and MLR values,and their clinical data were compared.The counting data were analyzed using the chi-square test,and the survival data were analyzed using Kaplan-Meier univariate analysis and Log-rank test.After univariate analysis,variables with statistical differences were included in Cox multivariate analysis to determine independent survival predictors.ROC curves of ALBI-PNI combination,ALBI-MLR combination,and MLR-PNI combination were depicted and compared with the corresponding ROC curves of ALBI,PNI,and MLR to evaluate their predictive value for the prognosis of HCC patients after TACE treatment.The predictive results with statistically significant and better performance were subjected to Kaplan-Meier univariate survival analysis and Log-rank test with 0.05 as the criterion for significant differences.Result:(1)The ROC curve analysis showed that the optimal cutoff values for ALBI,PNI,and MLR were-2.39,48.53,and 0.32,respectively.(2)The total survival time(OS)of 90 patients ranged from 31 to 365 days,with an average OS of 203 days and a median OS of 158 days.The number of deaths by the one-year follow-up date was 59,and the one-year survival rate of HCC patients after TACE treatment was 34.4%.(3)There were significant differences and correlations(P<0.05)between ALBI and clinical baseline indicators such as smoking history,TBIL,ALB,cirrhosis,ascites,and Child-Pugh score.Similarly,PNI showed significant differences and correlations(P<0.05)with clinical baseline indicators such as gender,smoking history,TBIL,ALB,cirrhosis,ascites,and Child-Pugh score.(4)Univariate analysis results showed that smoking history,ALB,extrahepatic metastasis,ascites,AST,ALBI,PNI,and MLR were risk factors affecting the prognosis of liver cancer patients after transarterial chemoembolization(TACE)treatment(P<0.05).Multivariate COX regression analysis showed that extrahepatic metastasis(HR=3.400,95%CI=1.540 ～ 7.504,P=0.002)、MLR(HR=2.026,95%,CI=1.178 ～ 3.483,P=0.011)、PNI(HR=4.014,95%CI=1.540～7.504,P=0.002)and ALBI(HR=5.549,95%,CI=2.209～13.935,P<0.001)were independent risk factors affecting the prognosis of HCC patients after TACE treatment(P<0.05).(5)The area under ROC curve(AUC)of ALBI-MLR combination was 0.690 and P=0.003.The area under ROC curve(AUC)of ALBI was 0.685,P=0.004.The area under ROC curve(AUC)of MLR was 0.634,P=0.034.The area under ROC curve(AUC)of ALBI and MLR combined was larger than that of ALBI and MLR alone,and the P value was the smallest.In conclusion,the combination of ALBI and MLR in predicting the postoperative prognosis of TACE has a better effect than that of ALBI and MLR alone.(6)According to preoperative ALBI-MLR combination,grouping based on ALBI-MLR showed that the group with ALBI≤-2.39 and MLR≤0.32 had the best performance,and there was a statistically significant difference in survival between ALBI-MLR groups(P<0.001).Conclusion:(1)Smoking history,albumin(ALB),extrahepatic metastasis,ascites,aspartate aminotransferase(AST),ALBI,prognostic nutritional index(PNI),and monocyte-to-lymphocyte ratio(MLR)are risk factors that affect the postoperative prognosis of patients undergoing transarterial chemoembolization(TACE)for liver cancer.(2)Extrahepatic metastasis MLR、PNI and ALBI are independent risk factors that affect the postoperative prognosis of patients undergoing transarterial chemoembolization(TACE)for liver cancer.(3)The combination of ALBI and MLR has a higher predictive value for postoperative prognosis evaluation of patients undergoing transarterial chemoembolization(TACE)compared to ALBI or MLR alone.(4)The combination of ALBI and MLR is a risk factor that affects the postoperative prognosis of patients undergoing transarterial chemoembolization(TACE)for liver cancer.