Purpose: To evaluate the efficacy of the neutrophil/lymphocyte-albumin-bilirubin (NALBI) Grade in predicting overall survival (OS) in patients with hepatocellular carcinoma (HCC) who meet the Milan Criteria prior to transarterial chemoembolism (TACE).
Material and Methods: This retrospective study reviewed 104 patients within Milan Criteria (MC) who underwent TACE between 2011 and 2017 and have not been transplanted. Pre-TACE NALBI grades were analyzed using univariate and multivariate Cox regression hazard models and Kaplan-Meier survival curves. NALBI criteria is defined as previously described (Wen et al., J Vasc Interv Radiol, 2019;30:S267) by neutrophil/lymphocyte ratio (NLR) > 2.8 = 1 pt , albumin < 3.3 mg/dL = 1 pt, and bilirubin > 2 mg/dL = 2pt. The NALBI score is defined by the point sum from each parameter. The NALBI grade is stratified into A (0 pts), B (1-2 pts) and C (3-5 pts).
Results: Uni- and multivariate regression analysis demonstrated that pre-TACE NLR > 2.8, serum albumin < 3.3 mg/dL and serum bilirubin > 2 mg/dL were adversely associated with OS (all p ≤ 0.01). Median OS by NALBI score was > 80, 28.5 and 5.5 months respectively for grades A, B and C. The survival rates for grades A-C respectively were 87%, 66% and 0% at 1 year and 64%, 34% and 0% at 5 years.
Conclusions: The NALBI grade significantly predicts and stratifies OS for patients with HCC who meet MC. This grading system can be useful tool to guide care management and follow-up time.