Effect of Transarterial Chemoembolization on ALBI Grade in Intermediate-Stage Hepatocellular Carcinoma: Criteria for Unsuitable Cases Selection

SIMPLE SUMMARY: BCLC-B HCC encompasses heterogeneous populations with varied tumor burden and liver reserve resulting in diverse clinical outcomes to TACE. Liver function deterioration would happen after TACE in patients with high tumor burden. Here, we found that the risk of post-TACE acute ALBI-grade migration was 24.3% and chronic ALBI-grade migration was 16% for BCLC-B HCC patients; HBV infection, up-to-seven criteria, and up-to-eleven criteria were factors of acute ALBI-grade migration, whereas bilobar tumor involvement had high risk of chronic ALBI migration once acute ALBI-grade migration developed after TACE. Overall, up-to-eleven criteria consistently associated with acute and chronic ALBI-grade migration, suggesting that up-to-eleven is an appropriate parameter to select TACE-unsuitable HCC patients who are at risk of liver function deterioration. In addition, patients with ALBI-grade migration in acute or chronic phases had significantly poorer PFS than patients without ALBI-grade migration. ABSTRACT: Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC). We aimed to identify unsuitable cases who were at risk of ALBI-grade migration by TACE. Consecutive 531 BCLC-B HCC patients undergoing TACE were reviewed, and factors associated with ALBI-grade migration were analyzed. There were 129 (24.3%) patients experienced acute ALBI-grade migration after TACE, and 85 (65.9%) out of the 129 patients had chronic ALBI-grade migration. Incidences of acute ALBI-grade migration were 13.9%, 29.0% for patients within or beyond up-to-7 criteria (p < 0.001) and 20.0%, 36.2% for patients within or beyond up-to-11 criteria (p < 0.001), respectively. HBV infection, tumor size plus tumor number criteria were risk factors associated with acute ALBI-grade migration. Bilobar tumor involvement was the risk factor of chronic ALBI-grade migration in patients with acute ALBI-grade migration. Up-to-eleven (p = 0.007) performed better than up-to-seven (p = 0.146) to differentiate risk of dynamic ALBI score changes. Moreover, ALBI-grade migration to grade 3 has adverse effect on survival. In conclusion, tumor burden beyond up-to-eleven was associated with ALBI-grade migration after TACE, indicating that up-to-eleven can select TACE-unsuitable HCC patients who are at risk of liver function deterioration.