BALAD and BALAD-2 predict survival of hepatocellular carcinoma patients: a North American cohort study |
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Authors: | Nicha Wongjarupong Gabriela M. Negron-Ocasio Kristin C. Mara Kritika Prasai Mohamed A. Abdallah Keun Soo Ahn Ju Dong Yang Benyam D. Addissie Nasra H. Giama William S. Harmsen Terry M. Therneau Lewis R. Roberts |
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Affiliation: | 1. Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA;2. Department of Internal Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA;3. University of Puerto Rico Medical Sciences Campus, Paseo Dr. Jose Celso Barbosa, San Juan, PR, 00921, USA;4. Department of Surgery, Keimyung University Dongsan Hospital, 1035 Dalgubeol-daero, Sindang-dong, Dalseo-gu, Daegu, 41931, Republic of Korea;5. Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA |
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Abstract: | BackgroundThe BALAD score and BALAD-2 class derived from bilirubin, albumin, AFP, AFP-L3, and des-gamma-carboxyprothrombin (DCP) are effective in predicting mortality in HCC, but have not been validated in North America.Methods148 HCC patients from 2000 to 2015 who had all five biomarkers tested at diagnosis were included. Hazard ratios (HR) were calculated.Results75 patients died during a median follow-up of 21.9 months. 1-and 3-year survival rates were 70.8% and 47.6%. 114 (77%) had cirrhosis. The HR (95%CI) for death were 1.24 (0.42–3.67), 1.79 (0.61–5.26), 2.83 (0.95–8.38), and 7.19 (2.26–22.91) for BALAD scores 1, 2, 3, and 4 vs. BALAD 0. The HR (95%CI) for death were 1.25 (0.65–2.40), 1.75 (0.94–3.23), and 6.20 (3.29–11.68) for BALAD-2 classes 2, 3, and 4 vs. BALAD-2 class 1. A multivariate model incorporating maximal tumor diameter, tumor number, neutrophil-lymphocyte ratio, and BALAD had HR of 1.43 (1.14–1.81) per increase of 1 BALAD score. A similar model with BALAD-2 had HR of 1.50 (1.18–1.90) per increase of 1 BALAD-2 class.ConclusionBALAD models at diagnosis can predict the survival of HCC patients in North America. AFP, AFP-L3, and DCP reflect tumor progression and metastasis of HCC and distinguish the BALAD model from other predictive models. |
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