E0512 - Comparison of Different Bedside Scores in Predicting Recurrence Post Trans-Arterial Chemoembolization in Patients With Hepatocellular Carcinoma

Introduction: Hepatocellular carcinoma (HCC) is one of the most common malignancies with high morbidity and mortality. Recently, the use of inflammatory and molecular biomarkers has been advocated to predict the prognosis in HCC patients after surgical hepatectomy. However, little work has been done to evaluate the use of these inflammatory markers in predicting post TACE HCC recurrence. The aim of our study was to compare different bed side scores in predicting recurrence post TACE in patients with HCC.

Methods: It was a cross-sectional study. All the patients with HCC undergoing TACE were included in the study. AUROC was derived for different scores including Lympocyte to Monocyte Ratio (LMR), Platelet to Lymphocyte Ratio (PLR), Neutrophil to Lymphocyte Ratio (NLR), Platelet to White blood cell Ratio (PWR) and NLR/Albumin(ALB) and their sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated for predicting post TACE recurrence in HCC patients.

Results: A total of 323 patients were included in the study. Among them, 281 (87%) were males. Mean age was 53±12.5 years. Mostly patients had single tumor 274(84.8%). BCLC stage A was noted in 274(84.8%) and stage B was seen in 49(15.2%) patients. Post TACE, patients were followed up to 1 year. Recurrence was noted in 186(57.6%) patients. On non-invasive investigations, increased neutrophils (p = ≤ 0.001), monocytes (p =0.002), platelets (p = 0.004), serum alpha-fetoprotein (p = ≤0.001) and decreased lymphocytes (p = ≤0.001) and serum albumin (p = ≤0.001) at baseline were significantly associated with post -TACE recurrence. NLR, PLR, LMR, PWR and NLR/Albumin ratio were calculated and multivariate analysis was done showing significant association of PLR, NLR and LMR with post TACE recurrence. Area under the curve was also obtained for these scores. The area under the curve of PLR (AUC:0.90) for predicting recurrence post TACE was higher than that of NLR (AUC:0.84), LMR(AUC:0.82), NLR/Albumin(AUC:0.75) and PWR(AUC:0.60). Sensitivity, specificity, PPV, NPV and diagnostic accuracy for each score was calculated. At a cutoff of >3.4, the sensitivity, specificity, PPV, NPV for PLR were 98.4%,72.3%,82.8%,97% with diagnostic accuracy of 87.3% in predicting post TACE recurrence of HCC.

Discussion: Different non-invasive scores for prediction of post TACE HCC recurrence have been compared and the diagnostic accuracy was highest for platelet to lymphocyte ratio (87.3%). However, further studies are needed to validate these scores.