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30.05.2022 | Review Article

Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis

verfasst von: Gauri Mishra, Ammar Majeed, Anouk Dev, Guy D. Eslick, David J. Pinato, Hirofumi Izumoto, Atsushi Hiraoka, Teh-Ia Huo, Po-Hong Liu, Philip J. Johnson, Stuart K. Roberts

Erschienen in: Journal of Gastrointestinal Cancer | Ausgabe 2/2023

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Abstract

Purpose

Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies.

Methods

Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software.

Results

Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol–related liver disease were significant in the ALBI grade 3 group (P < 0.001).

Conclusions

High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.

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Fitzmaurice C, Akinyemiju TF, Al Lami FH, Alam T, Alemayohu MA, Allen C, et al. Global burden of disease cancer collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the global burden of disease study. JAMA Oncol. 2018;4(11):1553–68.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin. 2018;68(6):394–424.PubMedCrossRef

Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, et al. EASL Clinical practice guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69:182–236.CrossRef

Díaz-González Á, Reig M, Bruix J. Treatment of hepatocellular carcinoma. Digest Dis. 2016;34(5):597–602.CrossRef

Lencioni R, Crocetti L, Simone P, Filipponi F. Loco-regional interventional treatment of hepatocellular carcinoma: Techniques, outcomes, and future prospects. Transplant Int. 2010;23(7):698–703.CrossRef

Raoul J-L, Forner A, Bolondi L, Cheung TT, Kloeckner R, de Baere T. Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence. Cancer Treat Rev. 2019;72:28–36.PubMedCrossRef

Raoul J-L, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev. 2011;37(3):212–20.PubMedCrossRef

Huo Y, Eslick GD. Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma: a systematic review and meta-analysis. JAMA Oncol. 2015;1(6):756–65.PubMedCrossRef

Cabibbo G, Genco C, Marco DV, Barbara M, Enea M, Parisi P, et al. Predicting survival in patients with hepatocellular carcinoma treated by transarterial chemoembolisation. Aliment Pharm Therap. 2011;34(2):196–204.CrossRef

10.

Pietrosi G, Miraglia R, Luca A, Vizzini GB, Fili D, Riccardo V, et al. Arterial chemoembolization/embolization and early complications after hepatocellular carcinoma treatment: a safe standardized protocol in selected patients with child class A and B cirrhosis. J Vasc Interv Radiol. 2009;20(7):896–902.PubMedCrossRef

11.

Lo C, Ngan H, Tso W, Liu CL, Lam CM, Poon TRP, et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology. 2002;35(5):1164–71.PubMedCrossRef

12.

Llovet JM, Real M, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet. 2002;359(9319):1734–9.PubMedCrossRef

13.

Takayasu K, Arii S, Kudo M, Ichida T, Matsui O, Izumi N, et al. Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines. J Hepatol. 2012;56(4):886–92.

14.

Burrel M, Reig M, Forner A, Barrufet M, de Lope CR, Tremosini S, et al. Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using drug eluting beads. Implications for clinical practice and trial design. J Hepatol. 2012;56(6):1330–5.

15.

Adhoute X, Pénaranda G, Raoul J, Edeline J, Blanc JF, Pol B, et al. Barcelona clinic liver cancer nomogram and others staging/scoring systems in a French hepatocellular carcinoma cohort. World J Gastroentero. 2017;23(14):2545–55.CrossRef

16.

Guarino M, Tortora R, Stefano G, Coppola C, Morisco F, Megna AS, et al. Adherence to Barcelona clinic liver cancer guidelines in field practice: Results of Progetto Epatocarcinoma Campania. J Gastroen Hepatol. 2018;33(5):1123–30.CrossRef

17.

Wallace MC, Huang Y, Preen DB, Garas G, Adams LA, MacQuillan G, et al. HKLC Triages more hepatocellular carcinoma patients to curative therapies compared to BCLC and is associated with better survival. Digest Dis Sci. 2017;62(8):2182–92.PubMedCrossRef

18.

Tovoli F, Negrini G, Bolondi L. Comparative analysis of current guidelines for the treatment of hepatocellular carcinoma. Hepatic Oncol. 2016;3(2):119–36.CrossRef

19.

Kudo M, Trevisani F, Abou-Alfa GK, Rimassa L. Hepatocellular carcinoma: Therapeutic guidelines and medical treatment. Liver Cancer. 2017;6(1):16–26.CrossRef

20.

Kudo M. Heterogeneity and subclassification of barcelona clinic liver cancer stage B. Liver Cancer. 2016;5(2):91–6.PubMedPubMedCentralCrossRef

21.

Bolondi L, Burroughs A, Dufour J-F, Mazzaferro V, Piscaglia F, Raoul JL, et al. Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: Proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis. 2012;32(04):348–59.PubMed

22.

Pinato D, Howell J, Ramaswami R, Sharma Rl. Review article: Delivering precision oncology in intermediate‐stage liver cancer. Alimentary Pharmacol Ther. 2017;45(12):1514–23.

23.

Sieghart W, Hucke F, Peck-Radosavljevic M. Transarterial chemoembolization: Modalities, indication, and patient selection. J Hepatol. 2015;62(5):1187–95.PubMedCrossRef

24.

Garwood ER, Fidelman N, Hoch SE, Hoch SE, Kerlan RK, Yao FY. Morbidity and mortality following transarterial liver chemoembolization in patients with hepatocellular carcinoma and synthetic hepatic dysfunction. Liver Transplant. 2013;19(2):164–73.CrossRef

25.

Kloeckner R, Pitton MB, Dueber C, Schmidtmann I, Galle PR, Koch S, et al. Validation of clinical scoring systems ART and ABCR after transarterial chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol. 2017;28(1):94–102.PubMedCrossRef

26.

Brown DB, Fundakowski CE, Lisker-Melman M, Crippin JS, Pigram TK, Chapman W, et al. Comparison of MELD and child-pugh scores to predict survival after chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol. 2004;15(11):1209–18.

27.

Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. J Clin Oncol. 2014;33(6):550–8.PubMedPubMedCentralCrossRef

28.

Pinato DJ, Sharma R, Allara E, Yen C, Arizumi T, Kubota K, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol. 2017;66(2):338–46.PubMedCrossRef

29.

Jaruvongvanich V, Sempokuya T, Wong L. Is there an optimal staging system or liver reserve model that can predict outcome in hepatocellular carcinoma? J Gastrointest Oncol. 2018;9(4):750–61.PubMedPubMedCentralCrossRef

30.

Campani C, Vitale A, Dragoni G, Arena U, Giannin EG, Trevisani F, et al. The ALBI and p-ALBI grades predict survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolization (TACE). Digest Liver Dis. 2018;50(1):44.CrossRef

31.

Kim J, Sinn D, Lee J-H, Hyun D, Cho SK, Shin SW, et al. Novel albumin–bilirubin grade-based risk prediction model for patients with hepatocellular carcinoma undergoing chemoembolization. Digest Dis Sci. 2018;63(4):1062–71.PubMedCrossRef

32.

Huo T-I, Liu P-H, Hsu C-Y. ALBI score as a novel tool in staging and treatment planning for hepatocellular carcinoma: is it sufficient. Liver Cancer. 2017;6(4):375–6.PubMedPubMedCentralCrossRef

33.

Hiraoka A, Kumada T, Michitaka K, Toyoda H, Tada T, Ueki H, et al. Usefulness of albumin–bilirubin grade for evaluation of prognosis of 2584 Japanese patients with hepatocellular carcinoma. J Gastroen Hepatol. 2016;31(5):1031–6.CrossRef

34.

Waked I, Berhane S, Toyoda H, Chan SL, Stern N, Palmer D, et al. Transarterial chemo-embolisation of hepatocellular carcinoma: Impact of liver function and vascular invasion. Brit J Cancer. 2017;116(4):448–54.PubMedPubMedCentralCrossRef

35.

Hansmann J, Evers MJ, Bui JT, Lokken RP, Lipnik AJ, Gaba RC, et al. Albumin-bilirubin and platelet-albumin-bilirubin grades accurately predict overall survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol. 2017;28(9):1224-1231.e2.PubMedCrossRef

36.

Hickey R, Mouli S, Kulik L, Desai K, Thornburg B, Ganger D, et al. Independent analysis of albumin-bilirubin grade in a 765-patient cohort treated with transarterial locoregional therapy for hepatocellular carcinoma. J Vasc Interv Radiol. 2016;27(6):795–802.PubMedCrossRef

37.

Aravind P, Thillai K, Suddle A, Heaton N, Karani J, Kane P, et al. Application of ALBI and PALBI score as prognostic variables in hepatocellular carcinoma patients treated with transarterial-chemoembolization. J Clin Oncol. 2017;35(4_suppl):241–241.

38.

Hiraoka A, Kumada T, Kudo M, Hirooka M, Koizumi Y, Hiasa Y, et al. Hepatic function during repeated TACE procedures and prognosis after introducing sorafenib in patients with unresectable hepatocellular carcinoma: Multicentre analysis. Digest Dis. 2017;35(6):602–10.CrossRef

39.

Carling U, Røsok B, Line PD, Dorenberg EJ. ALBI and P-ALBI grade in child-pugh A patients treated with drug eluting embolic chemoembolization for hepatocellular carcinoma. Acta Radiol. 2018;60(6):702–9.PubMedCrossRef

40.

Liu P, Hsu C, Hsia C, Lee YH, Chiou YY, Huang YH, et al. ALBI and PALBI grade predict survival for HCC across treatment modalities and BCLC stages in the MELD Era. J Gastroen Hepatol. 2017;32(4):879–86.CrossRef

41.

Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef

42.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.PubMedPubMedCentralCrossRef

43.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.PubMedPubMedCentralCrossRef

44.

Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391:1301–14.PubMedCrossRef

45.

Granito A, Bolondi L. Non-transplant therapies for patients with hepatocellular carcinoma and child-pugh-turcotte class B cirrhosis. Lancet Oncol. 2017;18(2):e101–12.PubMedCrossRef

46.

Chan A, Kumada T, Toyoda H, Tada T, Chong C, Mo F, et al. Integration of albumin–bilirubin (ALBI) score into Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma. J Gastroen Hepatol. 2016;31(7):1300–6.CrossRef

47.

Piscaglia F, Bolondi L. The intermediate hepatocellular carcinoma stage: Should treatment be expanded? Digest Liver Dis. 2010;42:S258–63.CrossRef

48.

Toyoda H, Kumada T, Tada T, Yama T, Mizuno K, Sone Y, et al. Differences in the impact of prognostic factors for hepatocellular carcinoma over time. Cancer Sci. 2017;108(12):2438–44.PubMedPubMedCentralCrossRef

49.

Lee S, Song M, Kim S, Park M. Comparing various scoring system for predicting overall survival according to treatment modalities in hepatocellular carcinoma focused on Platelet-albumin-bilirubin (PALBI) and albumin-bilirubin (ALBI) grade: a nationwide cohort study. PLoS One. 2019;14(5): e0216173.PubMedPubMedCentralCrossRef

50.

Ho S, Liu, Hsu C, Hsia CY, Lee YH, Lee RC, et al. Prognostic role of noninvasive liver reserve markers in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. PLoS One. 2017;12(7).

51.

Prins P, Sharma T, Kim KS, Bhardwaj PV, Collins N, Lu E, et al. Change in liver function as measured by change of child pugh score to predict survival in patients with advanced hepatocellular carcinoma (HCC) during the treatment course. J Clin Oncol. 2018;36(suppl 4):S310.CrossRef

52.

Hass HG, Markmann H, Schaffer M, Wellhauber U, Smith U, Denzlinger C. Diagnostic and prognostic aspects of hepatocellular carcinoma – a retrospective analysis in 145 patients. J Gastroenterol Hepatol Res. 2017;6(3):2358–64.CrossRef

53.

Georgiades CS, Liapi E, Frangakis C, Park J, Kim HW, Hong K, et al. Prognostic accuracy of 12 liver staging systems in patients with unresectable hepatocellular carcinoma treated with transarterial chemoembolization. J Vasc Interv Radiol. 2006;17(10):1619–24.PubMedCrossRef

54.

Schellhaas B, Strobel D, Stumpf M, Ganslmayer M, Pfeifer L, Goertz RS, et al. Improvement of clinical management and outcome in hepatocellular carcinoma nowadays compared with historical cohorts. Eur J Gastroen Hepat. 2018;30(12):1422–7.CrossRef

55.

Giannini E, Bucci L, Garuti F, Brunacci M, Lenzi B, Valente M, et al. Patients with advanced hepatocellular carcinoma need a personalized management: a lesson from clinical practice. Hepatology. 2018;67(5):1784–96.PubMedCrossRef

56.

Giannini EG, Savarino V, Risso D, Di Nolfo MA, Del Poggio P, Benvegnu L, et al. Transarterial chemoembolization in child–pugh class B patients with hepatocellular carcinoma: Between the devil and the deep blue sea. Liver Int. 2010;30(6):923–4.PubMedCrossRef

57.

Xu Y, Wang Y, Tan Y, Cheng X, Xu XZ. Prognostic value of pretreatment albumin to bilirubin ratio in patients with hepatocellular cancer. Medicine. 2019;98(2).

58.

Demirtas CO, D’Alessio A, Rimassa L, Sharma R, Pinato DJ. ALBI grade: evidence for an improved model for liver functional estimation in patients with hepatocellular carcinoma. JHEP Rep: Innov Hepatol. 2021;3(5): 100347.CrossRef

59.

Cai X-R, Chen Z-H, Liu M-M, Lin JX, Zhang XP, et al. Modified CLIP score with the albumin-bilirubin grade retains prognostic value in HBV-related hepatocellular carcinoma patients treated with trans-catheter arterial chemoembolization therapy. J Cancer. 2018;9(13):2380–8.PubMedPubMedCentralCrossRef

60.

Ueshima K, Nishida N, Hagiwara S, Aoki T, Minami T, Chishina H, et al. Impact of baseline ALBI grade on the outcomes of hepatocellular carcinoma patients treated with lenvatinib: a multicenter study. Cancers. 2019;11(7):952.PubMedPubMedCentralCrossRef

61.

Yukimoto A, Hirooka M, Hiraoka A, Michitaka K, Ochi H, Joko K, et al. Using ALBI grade at the start of sorafenib treatment to predict regorafenib treatment candidates in patients with hepatocellular carcinoma. Jpn J Clin Oncol. 2019;49(1):42–7.PubMedCrossRef

62.

Edeline J, Blanc JF, Johnson P, Campillo-Gimenez B, Ross P, Ma YTA. multicentre comparison between child pugh and albumin-bilirubin grades in patients treated with sorafenib for hepatocellular carcinoma. Liver Int. 2016;36(12):1821–8.PubMedCrossRef

63.

Kim HD, Bang Y, Lee MA, Kim JW, Kim JH, Chon HJ. Regorafenib in patients with advanced Child-Pugh B hepatocellular carcinoma: a multicentre retrospective study. Liver Int. 2020;40(10):2544–52.PubMedCrossRef

64.

Vogel A, Frenette C, Sung MW, Daniele B, Baron AD, Chan SL. Baseline liver function and outcomes in the phase III REFLECT study in patients with unresectable hepatocellular carcinoma (uHCC). JClin Oncol. 2020;38(4_suppl):524–524.

65.

Lee PC, Chao Y, Chen MH, Lan KH, Lee CJ, Lee IC. Predictors of response and survival in immune checkpoint inhibitor-treated unresectable hepatocellular carcinoma. Cancers (Basel). 2020;12(1):182.

66.

Chan SL, Miksad R, Cicin I, Chen Y, Klumpen HJ, Kim S. Outcomes based on albumin-bilirubin (ALBI) grade in the phase III CELESTIAL trial of cabozantinib versus placebo in patients with advanced hepatocellular carcinoma (HCC). Ann Oncol. 2019;30:ix45–6

67.

Pinato DJ, Kaneko T, Saeed A, Pressiani T, Kaseb A, Wang Y. Immunotherapy in hepatocellular cancer patients with mild to severe liver dysfunction: adjunctive role of the ALBI grade. Cancers (Basel). 2020;12(7):1862.PubMedCrossRef

68.

Ni JY, Fang ZT, Sun HL, An C, Huang ZM, Zhang TQ. A nomogram to predict survival of patients with intermediate-stage hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation. Eur Radiol. 2020;30(4):2377–90.PubMedCrossRef

69.

Shimose S, Tanaka M, Iwamoto H, Niizeki T, Shirono T, Aino H, et al. Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision-tree analysis after propensity grade matching. Hepatol Res. 2019;49(8):919–28.PubMedCrossRef

70.

Gui B, Weiner AA, Nosher J, Lu SE, Foltz GM, Hasan O, et al. Assessment of the albumin-bilirubin (ALBI) grade as a prognostic indicator for hepatocellular carcinoma patients treated with radioembolization. Am J Clin Oncol. 2018;41(9):861–6.PubMedPubMedCentralCrossRef

71.

Toyoda H, Lai PB, O’Beirne J, Chong CC, Berhane S, Reeves H, et al. Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade. Br J Cancer. 2016;114(7):744–50.PubMedPubMedCentralCrossRef

72.

Kudo M. Newly developed modified ALBI grade shows better prognostic and predictive value for hepatocellular carcinoma. Liver Cancer. 2022;11:1–8.PubMedCrossRef

73.

Deng M, Ng SWY, Cheung ST, Chong CCN. Clinical application of albumin-bilirubin (ALBI) score: the current status. Surgeon. 2020;18(3):178–86.PubMedCrossRef

74.

Vogeler M, Mohr I, Pfeiffenberger J, Sprengel SD, Klauss M, Teufel A, et al. Applicability of scoring systems predicting outcome of transarterial chemoembolization for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2020;146(4):1033–50.PubMedPubMedCentralCrossRef

75.

Liu Y, Cheng C, Zhou H, Hu S, Wang H, Xie Q, Lei L, Wang P, Liu G, Hu H. Comparison of modified child-pugh (MCP), albumin-bilirubin (ALBI), and child-pugh (CP) grade for predicting of survival in hepatocellular carcinoma patients treated with transcatheter arterial chemoembolization. Bull Cancer. 2021;108(10):931–9.

76.

Jia KF, Wang H, Yu CL, Yin WL, Zhang XD, Wang F, Sun C, Shen W. ASARA, a prediction model based on child-pugh class in hepatocellular carcinoma patients undergoing transarterial chemoembolization. Hepatobiliary Pancreat Dis Int. 2022;S1499–3872(22):00015–7.

77.

Campani C, Vitale A, Dragoni G, Arena U, Laffi G, Cillo U, et al. Time-varying mHAP-III is the most accurate predictor of survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Liver Cancer. 2021;10(2):126–36.PubMedPubMedCentralCrossRef

78.

Hiraoka A, Kumada T, Tsuji K, Takaguchi K, Itobayashi E, Kariyama K, et al. Validation of modified ALBI grade for more detailed assessment of hepatic function in hepatocellular carcinoma patients: a multicenter analysis. Liver Cancer. 2019;8(2):121–9.PubMedCrossRef

Titel: Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis
verfasst von: Gauri Mishra
Ammar Majeed
Anouk Dev
Guy D. Eslick
David J. Pinato
Hirofumi Izumoto
Atsushi Hiraoka
Teh-Ia Huo
Po-Hong Liu
Philip J. Johnson
Stuart K. Roberts
Publikationsdatum: 30.05.2022
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Cancer / Ausgabe 2/2023
Print ISSN: 1941-6628
Elektronische ISSN: 1941-6636
DOI: https://doi.org/10.1007/s12029-022-00832-0

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Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis