Effects of TACE combined with sorafenib on survival of patients with hepatocellular carcinoma based on ALBI grades and tumor load layers And Establishment of prognosis prediction model

Abstract

Abstract Background Hepatocellular Carcinoma (HCC) is the fourth most common malignant tumor in China and the second leading cause of cancer-related death. Transcatheter arterial chemoembolization (TACE) and targeted therapy are widely used in the treatment of HCC. To make a better treatment strategy from many treatment options, this study analyzed the survival of patients with liver cancer based on Albumin-Bilirubin (ALBI) grades and tumor load layer, and established a nomogram model. Methods The clinical data of 354 patients with unresectable HCC and recurrent HCC after radical resection who received TACE combined with or without sorafenib(SORA) in our hospital from 2017 to 2020 were investigated retrospectively.After 1:2 propensity score matching (PSM), eighty-one cases in TACE + SORA group and 162 cases in TACE group were included. Results The survival benefit of TACE combined with sorafenib is better than that of TACE alone in patients with advanced liver cancer and recurrent primary liver cancer after radical surgery. Compared with TACE alone, patients with good liver function reserve (ALBI grade 1_5 points) can benefit significantly from TACE combined with SORA (median PFS: 11.8 months vs 7.0 months, P=0.000; median OS: 27.6 months vs 23.0 months, P=0.019). For patients with poor liver function (such as ALBI grade 1_ grade B), combined therapy can not significantly prolong the survival of patients with liver cancer(median PFS: P=0.370; median OS: P=0.131). ALBI grades is superior to Child-Pugh grades in predicting the prognosis of HCC. The prognosis of patients with large tumor burden ((layer 2 and layer 3) is better than that of patients with TACE alone(layer 2: 24.5 months vs 18.5 months, layer 3: 15.0 months vs 12.2 months; P<0.05). The nomogram prediction model can predict the prognosis of patients with unresectable liver cancer and patients with recurrence of liver cancer(C-index and AUC: 0.846 and 0.703, respectively)(C index range in predicting OS in 1, 2 and 3 years: 0.707-0.928), and it is also a good risk stratification model. Nomograph model based on ALBI grades is better than nomograph model based on Child-Pugh grades (0.844 vs 0.839). Conclusions Compared with TACE alone, the combination of TACE and sorafenib could improve the prognosis of patients, especially the patients with better liver function (ALBI grade 1_5points) and the patients with higher tumor load,such as layer 2 and 3. The nomogram model established in this study performed well in predicting prognosis, and the model could be used for risk stratification of patients.