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Promising Biomarker Predicts TARE Treatment Response in HCC

The albumin-bilirubin score is a reliable predictor of treatment response for hepatocellular carcinoma (HCC) after yttrium 90 transarterial radioembolization (TARE).

A study that evaluated biomarkers related to fibrosis, liver function, and immune inflammation showed that lower albumin-bilirubin (ALBI) scores correlated with favorable tumor response to treatment with yttrium 90 (Y90) transarterial radioembolization (TARE). The findings of the retrospective pilot study were published in Cureus.1

Patients with ALBI scores of –2.8 or less had a significantly higher probability of a good response, with an OR of 5.8 (95% CI, 1.2-27.6; P = .03). Patients with a neutrophil-to-lymphocyte ratio (NLR) of 1.92 or less had a higher likelihood of a good response, but the association was not statistically significant (OR, 4.7; 95% CI, 0.8-27.5; P = .08).

“The NLR index may offer further prognostic information, and both biomarkers [the ALBI score and the NLR ratio] can be used in combination. However, further research in larger sample sets is necessary to confirm the NLR's statistical significance,” the authors concluded.

A simulated logistic regression analysis in which the sample size was doubled showed that the association between treatment response and NLR could become statistically significant (P = .02).

The study comprised adults diagnosed with hepatocellular carcinoma (HCC) between January 2020 and December 2021 with the following characteristics: 77% were male, 63% were White non-Hispanic, 17% were Black non-Hispanic, 21% were Hispanic, 91% were diagnosed with cirrhosis, and 40% had a viral etiology. Patients with recent esophageal or gastric bleeding, uncontrolled hepatic encephalopathy, cardiac failure, renal failure, sepsis, or evidence of extrahepatic metastases were excluded.

Only patients who underwent Y90 therapy after discussion in a multidisciplinary tumor board were included. All study participants underwent radiotherapy for bridging, downstaging, or palliative treatment. After therapy, each patient received contrast-enhanced CT or MRI scans every 3 months, until a multidisciplinary tumor board recommended a change in therapy.

liver health | Image Credit: shidlovski-stock.adobe.com

In this investigation, lower albumin-bilirubin scores correlated with favorable tumor response to treatment with yttrium 90 transarterial radioembolization| Image Credit: shidlovski-stock.adobe.com

Slightly more than half (51%) of the study’s 35 patients were classified as treatment responders (complete and partial response), according to modified Response Evaluation Criteria in Solid Tumors (mRECIST). Responders showed a higher mean value of albumin compared with nonresponders (stable and progressive disease) (4.1 vs 3.6; P < .02).

The Liver Imaging Reporting and Data System version 2018 classifications, which the investigators used to base HCC diagnoses on, were predominantly LR-5 (89%), indicating a high likelihood that a lesion is HCC.2 The number of Y90 treatments varied: 63% of patients received 3 treatments, 34% received 2 treatments, and 3% received 1 treatment. Types of Y90 treatment were radiation segmentectomy (63%) lobectomy (23%), and standard TARE (15%).

Biomarkers that did not show a statistically significant correlation with positive treatment response included aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4, model for end-stage liver disease (MELD) score, MELD sodium, and the systemic immune-inflammatory indexes (systemic immune index, NLR, and platelet-to-lymphocyte ratio).

Simulated analysis with a larger sample size, however, suggested a statistically significant association with the APRI. The authors concluded that a larger sample size would also help establish cutoff values for fibrosis-4 and the systemic immune-inflammatory indexes, and enable associations between predictors with 3 or more categories.

Five years after a diagnosis of HCC, the survival rate is 21%.3

Overall survival rates are similar between TARE and transarterial chemoembolization, but not all patients respond to these treatments. There is a need to identify prognostic indicators and biomarkers to better predict treatment responses and design therapies accordingly, the authors noted.

The study “suggested a potential synergistic relationship between the ALBI score and NLR in predicting HCC TARE response. This insight provides a novel approach to assessing treatment outcomes by combining 2 readily accessible markers,” the authors concluded.

References

1. Bayona Molano M, Kolber M, Barrera JV, et al. Prognostic value of liver biomarkers in hepatocellular carcinoma patients undergoing yttrium 90 transarterial radioembolization (TARE): a retrospective pilot study. Cureus. 2024;16(6):e61904. doi:10.7759/cureus.6190

2. How to read your liver imaging report using LI-RADS.RadiologyInfo.org. Accessed June 18, 2024. https://www.radiologyinfo.org/en/info/article-lirads-liver-imaging

3. Hepatocellular carcinoma (HCC). Cleveland Clinic. Accessed June 17, 2024. https://my.clevelandclinic.org/health/diseases/21709-hepatocellular-carcinoma-hcc

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