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.

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.

• Authors: Atsushi Hiraoka, Masaya Kato, Kaori Marui, Taisei Murakami, Kei Onishi, Tomoko Adachi, Junko Matsuoka, Hidetaro Ueki, Takeaki Yoshino, Miho Tsuruta, Toshihiko Aibiki, Tomonari Okudaira, Taira Kuroda, Ryuichiro Iwasaki, Yoshifumi Suga, Hideki Miyata, Tomoyuki Ninomiya, Masashi Hirooka, Masanori Abe, Bunzo Matsuura, Kojiro Michitaka, Yoichi Hiasa
• Journal: Cancer medicine (Cancer Med) Vol. 10 Issue 11 Pg. 3584-3592 (06 2021) ISSN: 2045-7634 [Electronic] United States
• PMID: 33960691 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Chemical References

• Amino Acids, Branched-Chain
• Biomarkers
• Serum Albumin
• Tyrosine
• Bilirubin

Topics

• Aged
• Amino Acids, Branched-Chain (blood)
• Bilirubin (blood)
• Biomarkers (blood)
• Carcinoma, Hepatocellular (blood, mortality)
• Chronic Disease
• Epidemiologic Methods
• Female
• Humans
• Liver Diseases (blood, complications, mortality)
• Liver Neoplasms (blood, mortality)
• Male
• Nutritional Status
• Prognosis
• Protein-Energy Malnutrition (blood, diagnosis)
• Serum Albumin (analysis)
• Tyrosine (blood)