Easy clinical predictor for low BCAA to tyrosine ratio in chronic liver disease patients with hepatocellular carcinoma: Usefulness of ALBI score as nutritional prognostic marker. (7th May 2021)

• Record Type: Journal Article
• Authors: Hiraoka, Atsushi; Kato, Masaya; Marui, Kaori; Murakami, Taisei; Onishi, Kei; Adachi, Tomoko; Matsuoka, Junko; Ueki, Hidetaro; Yoshino, Takeaki; Tsuruta, Miho; Aibiki, Toshihiko; Okudaira, Tomonari; Kuroda, Taira; Iwasaki, Ryuichiro; Suga, Yoshifumi; Miyata, Hideki; Ninomiya, Tomoyuki; Hirooka, Masashi; Abe, Masanori; Matsuura, Bunzo; Michitaka, Kojiro; Hiasa, Yoichi
• Is Part Of: Cancer medicine. Volume 10:Number 11(2021)
• Page Start: 3584
• Page End: 3592
• Publication Date: 2021-05-07
• Subjects: albumin–bilirubin score -- amino acid imbalance -- branched‐chain amino acid to tyrosine ratio -- hepatocellular carcinoma -- modified ALBI grade -- nutrition; 616.994005
• DOI: 10.1002/cam4.3908
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background/Aim: Low branched‐chain amino acid (BCAA) to tyrosine ratio (BTR) is known as an indicator of amino acid imbalance. We elucidated usefulness of newly developed albumin–bilirubin (ALBI) score as alternative methods of BTR in patients with naïve hepatocellular carcinoma (HCC) retrospectively. Materials/Methods: In 842 patients with HCC and without BCAA supplementation (71 years, male 614, Child‐Pugh A:B:C = 689:116:37), relationships among BTR and clinical features were evaluated. Of those, 438 patients, with Milan criteria HCC, treated curatively were divided into the high‐BTR (>4.4) ( n = 293) and low‐BTR (≤4.4) ( n = 145) groups. The prognostic value of BTR was evaluated using inverse probability weighting (IPW) with propensity score. Results: The low‐BTR group showed worse prognosis than the other (3‐, 5‐, 10‐year overall survival rates: 88.9% vs. 86.3%/70.5% vs. 78.1%/38.1% vs. 52.3%, respectively; p < 0.001). Multivariate Cox‐hazard analysis adjusted for IPW showed elderly (≥65 years) HR 2.314, p = 0.001), female gender (HR 0.422, p < 0.001), ECOG PS ≥2 (HR 3.032, p = 0.002), low platelet count (HR 1.757, p = 0.010), and low BTR (≤4.4) (HR 1.852, p = 0.005) to be significant prognostic factors. Both serum albumin level ( r = 0.370, p < 0.001) and ALBI score ( r = −0.389, p < 0.001) showed a significant relationship with BTR. Child‐Pugh class B, modified ALBI grade (mALBI) 2a, and mALBI 2b predictive values for BTR were 3.589, 4.509, and 4.155 (AUC range: 0.735–0.770), respectively, while the predictive value of ALBI score for low‐BTR (≤4.4) was −2.588 (AUC 0.790). Conclusion: ALBI score −2.588 was a predictor for low‐BTR (≤4.4), which was prognostic factors for early HCC patients, and at least patients with mALBI 2b might have an amino acid imbalance. Abstract : This study was conducted to elucidate usefulness of newly developed albumin–bilirubin (ALBI) score as alternative methods of BTR for predicting amino acid imbalance that affects prognosis in naïve hepatocellular carcinoma (HCC) patients. ALBI score −2.588 was a predictor for low‐BTR (≤4.4), which was prognostic factors for early HCC patients, and at least patients with modified ALBI grade 2b (>−2.27) might have an amino acid imbalance.