Journal of hepatocellular carcinoma · 2025
The TBS-PALB-NLR Triad: A Novel Preoperative Prognostic System Guiding Therapeutic Decision-Making in Unresectable HCC Treated with Transarterial Chemoembolization.
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Yu Bin, Xu Lin, Yang Weihao, Yin Yu, Yang Jun, Miao Xiaoyun, Ni Caifang
Аннотация
PURPOSE: This study aimed to investigate the predictive value of the Tumor Burden Score (TBS) combined with Serum Prealbumin (PALB) and the Neutrophil-to-Lymphocyte Ratio (NLR) for the long-term prognosis of patients with unresectable hepatocellular carcinoma (uHCC) following transcatheter hepatic artery chemoembolization (TACE) therapy, and to elucidate its significance in guiding treatment planning.
PATIENTS AND METHODS: Clinical data from 940 patients with unresectable HCC who underwent TACE treatment at three hospitals in the Jiangsu Province between 2007 and 2018 were retrospectively analyzed. TBS was calculated using the formula: TBS2 = (maximum tumor diameter)2 + (number of tumors)2 (The diameter of the tumor is measured in centimeters). The optimal cutoff values for TBS and NLR were determined using R software. Patients were risk-stratified based on their TBS-PALB-NLR (TPN) score. Independent predictors associated with survival were identified using univariate and multivariate Cox proportional hazards regression analyses.
RESULTS: Independent risk factors identified through univariate Cox analysis included age, cirrhosis, ascites, BCLC stage, vascular invasion, NLR, TBS, PALB, AFP, Bilirubin, AST, and ALT. Multivariate analysis revealed that BCLC stage, NLR, TBS, and PALB were significant independent risk factors affecting overall survival (P < 0.05). The TPN score was established based on TBS, PALB, and NLR, and patients were stratified into low-TPN, intermediate-TPN, and high-TPN groups.
CONCLUSION: The TPN score is a low-cost, readily available prognostic tool that can effectively risk-stratify patients with uHCC. It may guide personalized adjuvant therapy (eg, systemic therapy for high-risk patients), particularly in resource-limited medical centers.
PATIENTS AND METHODS: Clinical data from 940 patients with unresectable HCC who underwent TACE treatment at three hospitals in the Jiangsu Province between 2007 and 2018 were retrospectively analyzed. TBS was calculated using the formula: TBS2 = (maximum tumor diameter)2 + (number of tumors)2 (The diameter of the tumor is measured in centimeters). The optimal cutoff values for TBS and NLR were determined using R software. Patients were risk-stratified based on their TBS-PALB-NLR (TPN) score. Independent predictors associated with survival were identified using univariate and multivariate Cox proportional hazards regression analyses.
RESULTS: Independent risk factors identified through univariate Cox analysis included age, cirrhosis, ascites, BCLC stage, vascular invasion, NLR, TBS, PALB, AFP, Bilirubin, AST, and ALT. Multivariate analysis revealed that BCLC stage, NLR, TBS, and PALB were significant independent risk factors affecting overall survival (P < 0.05). The TPN score was established based on TBS, PALB, and NLR, and patients were stratified into low-TPN, intermediate-TPN, and high-TPN groups.
CONCLUSION: The TPN score is a low-cost, readily available prognostic tool that can effectively risk-stratify patients with uHCC. It may guide personalized adjuvant therapy (eg, systemic therapy for high-risk patients), particularly in resource-limited medical centers.