الفهرس 
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Abstract
Summary and Conclusion
HCC is the fifth most common cancer in men and the seventh one in women and the third leading cause of cancer-related death. It is one of the leading causes of morbidity and mortality in patients with cirrhosis. A major obstacle hindering improvement in treatment outcome is the difficulty in predict¬ing treatment response, owing to the hetero¬geneity of not only the cancer itself but also the underlying chronic liver disease. In most cases, it presents on a background of chronic liver disease, and the interplay of the underlying liver disease and the cancer itself drives treatment decisions. The clinician must consider factors such as the stage and extent of tumor, the underlying liver function, and the patient’s performance status. There was always an intense need for a real prognostic system to asses liver reservoir in HCC patients.
In this study, we used data base from HCC clinic at National Liver Institute to identify objective measures of liver dysfunction that inde¬pendently influence survival in patients with HCC (albumin and bilirubin) and then combined them into a model that could be compared with the conventional CTP score. This resultant model, called the Albumin-Bilirubin (ALBI) score, eliminates the need for subjective variables such as ascites and encephalopathy, a require¬ment in the CTP score. We aimed to validate this resultant model in our study and compare it to newly developed models dependant on it as PALBI and ALBI-T scores.
This study was a retrospective-prospective cohort study, conducted on 415 patients who attended HCC clinic at National Liver Institute, from January 2013 to February 2014 and fulfilled the inclusion criteria which was all patients diagnosed with HCC with complete data and contact details while patients with incomplete data and contact can’t be reached were excluded from the study.
In our study we found that there were no significant correlation between age of patients and survival. HCC was more prevalent in males than females with a ratio of 3.2/1 (males accounted for 76.4% while females 23.6%). In most of our studied patients, the underlying etiology of HCC was HCV related cirrhosis (83.1%). In our study, we found that AFP level ≥200 ng/ml was significantly associated with worst survival (16 months) than AFP level < 200 ng/ml (28 months). Also, the prognosis of patient with single tumor nodule was much better than those with multiple nodules. Therefore, the number of nodules was significant baseline predictor of survival. Patients with single focal lesion had a median survival of 26 months while those with three, four and five nodules had a median survival of 15 months.
About 12% of our cohort was found to have PVT at the time of HCC diagnosis. Patients with PVT had significantly worse survival than those with patent portal vein (6 months vs. 26 months). In our study, patients with extrahepatic metastasis had a median survival 8 months while those with no metastasis, it was 25 months. Only 26.7 % of our patients had received best supportive care i.e. palliative care while majority (73.3 %) of our patients had received different treatment modalities.
In the present work, we found that patients with ALBI grade 1 had better median survival (33.8 months) than those with ALBI garde 2 and 3 (22.1 and 6.8 months respectively) which is statistically significant. We did further sub-classification for patients with ALBI grade 2 into ALBI grade 2 A and ALBI grade 2B. This sub-classification showed significant difference in survival (26. 3 & 16.9 months respectively).
Moreover, we found patients with PALBI grade 1 had a better median survival (34.6 months) than PALBI grade 2, 3 and 4 (27.5, 23.9 and 7.9 months respectively). In addition , we found that patients with ALBI-T grade 0 had mean survival 34.7 months and ALBI-T 1 was found to have better median survival (30.8 months) than ALBIT-T 2, 3, 4 & 5 (25.5, 10.7, 6.8 and 5.8 months respectively). On classifying CTP A patients using ALBI, PALBI and ALBI-T scores, we found that median survival increased in CTP A patients (was 29 months) after further classification by our tested scores to be 33.8 months in ALBI grade 1, 34.6 months in PALBI grade 1 , 34.7 & 30.8 months ALBI-T grade 0 &1 respectively.
In conclusion, ALBI score was found to be a new brilliant core score that classify patients with HCC according to liver functions better than CTP score. Further sub classification for ALBI grade 2, were found to be significantly superior to identify patients with better liver functions. In addition, PALBI and ALBI-T score were found to be better than ALBI score as a prognostic tool. However, ALBI-T score was found to be the best total prognostic scoring system for predicting survival of patients with HCC as it incorporates tumor stage to the liver reservoir through TNM to ALBI score combination.