Comparison of Four Albumin-Based Liver Reserve Models (ALBI/EZ-ALBI/PALBI/PAL) against MELD for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

SIMPLE SUMMARY: Liver functional reserve plays a critical role in the management of hepatocellular carcinoma (HCC) patients. The model for end-stage liver disease (MELD) is used to assess liver functional reserve in HCC patients. Alternatively, the albumin-bilirubin (ALBI) score and easy (EZ)-ALBI score, platelet-albumin-bilirubin (PALBI) score and platelet-albumin (PAL) score are also proposed to indicate liver reserve in HCC. We aimed to compare these four albumin-based liver reserve models (ALBI/EZ-ALBI/PALBI/PAL) against MELD for HCC patients undergoing transarterial chemoembolization (TACE). Among these models, the PALBI grade had the highest homogeneity and lowest corrected Akaike information criteria value, followed by EZ-ALBI, PAL, ALBI and lastly, MELD. All four albumin-based liver reserve models are better prognostic tools than MELD scores in patients undergoing TACE. Of these, the PALBI score is the best model to evaluate the liver reserve and should be considered a surrogate marker in these patients. ABSTRACT: (1) Background: The severity of liver functional reserve plays an important role in the management of hepatocellular carcinoma (HCC). Noninvasive models such as the model for end-stage liver disease (MELD), albumin-bilirubin (ALBI) grade and easy (EZ)-ALBI grade, platelet-albumin-bilirubin (PALBI) and platelet-albumin (PAL) are used to evaluate liver dysfunction. We aimed to compare the prognostic performance of these four albumin-based models against MELD in HCC patients undergoing transarterial chemoembolization (TACE). (2) Methods: A total of 1038 treatment naïve HCC patients who received TACE as the primary treatment were enrolled. A multivariate Cox model was used to determine independent survival predictors. (3) Results: Multivariate analysis revealed that higher serum creatinine and α-fetoprotein level, vascular invasion, large tumor size, ALBI grades 2–3, EZ-ALBI grades 2–3, PALBI grades 2–3, PAL grades 2–3, but not the MELD score, were independent predictors associated with decreased survival in different Cox models. Among these models, the PALBI grade had the highest homogeneity and lowest corrected Akaike information criteria value, followed by EZ-ALBI, PAL, ALBI and, lastly, MELD. (4) Conclusions: All four albumin-based liver reserve models are better prognostic tools than MELD score in HCC patients undergoing TACE. Of these, the PALBI score is the best model to evaluate the liver reserve and should be considered a surrogate marker in these patients.