Tesis

Pengaruh Derajat ALBI terhadap Outcome HepatocellularCarcinoma yang mendapat Stereotactic Body Radiotherapy = Influence of ALBI Grade on Outcomes in HepatocellularCarcinoma Treated with Stereotactic Body Radiotherapy.

Latar Belakang: Fungsi hati merupakan determinan utama luaran pasienhepatocellular carcinoma (HCC) yang menjalani stereotactic body radiotherapy(SBRT). Skor Albumin–Bilirubin (ALBI) adalah penilaian cadangan hati yangobjektif berbasis albumin dan bilirubin, serta telah divalidasi sebagai prediktorprognosis pada HCC.Tujuan: Menilai pengaruh derajat ALBI terhadap overall survival (OS) danprogression-free survival (PFS) pada pasien HCC yang mendapatkan SBRT diRSUPN Dr. Cipto Mangunkusumo (RSCM).Metode: Kohort retrospektif menggunakan data pasien HCC yang mendapat SBRTdi IPTOR RSCM periode Januari 2018–Desember 2024 (total sampling). OSdianalisis pada seluruh subjek, sedangkan PFS pada subjek dengan pencitraanpasca-SBRT. Analisis Kaplan–Meier/log-rank dan regresi Cox digunakan untukmemperoleh adjusted hazard ratio (AHR) dengan Confidence Interval (CI) 95%.Hasil: Dari 183 pasien terdaftar, 65 pasien dianalisis (ALBI 1: 31/65 [47,7%];ALBI 2: 30/65 [46,2%]; ALBI 3: 4/65 [6,2%]). Terdapat 42 kematian (64,6%).Median OS ALBI 1, 2, 3 berturut-turut 54,0; 19,0 (CI 95% 10,30–27,70); dan 5,0bulan (CI 95% 1,08–8,92) (log-rank p=0,003). Pada multivariat, setiap peningkatansatu derajat ALBI meningkatkan risiko kematian 80% (AHR 1,801; p=0,021).Untuk PFS, 45 pasien dianalisis (29 progresi; 64,4%); median PFS ALBI 1, 2, 3adalah 11,0 bulan (CI 95% 2,37–19,63), 4,0 bulan (CI 95% 1,80–6,20), dan 1,0bulan; dengan perbedaan bermakna (log-rank p < 0,001). Derajat ALBI merupakanprediktor independen progresi (AHR 2,569; p=0,027).Kesimpulan: Derajat ALBI berasosiasi dengan penurunan OS dan PFS secaragradien dan merupakan faktor prognostik independen pada pasien HCC yangmendapat SBRT di RSCM.
Kata kunci: hepatocellular carcinoma, stereotactic body radiotherapy, ALBI,Child–Pugh, overall survival, progression-free survival.


Background: Liver function is a key determinant of outcomes in patients withhepatocellular carcinoma (HCC) undergoing stereotactic body radiotherapy(SBRT). The Albumin–Bilirubin (ALBI) score is an objective assessment of hepaticreserve based on serum albumin and bilirubin and has been validated as aprognostic predictor in HCC.Objective: To evaluate the impact of ALBI grade on overall survival (OS) andprogression-free survival (PFS) in patients with HCC treated with SBRT at Dr.Cipto Mangunkusumo National General Hospital (RSCM).Methods: A retrospective cohort study was conducted using data from HCCpatients who received SBRT at the Radiation Oncology Integrated Service Unit(IPTOR) RSCM between January 2018 and December 2024 (total sampling). OSwas analyzed in all eligible patients, while PFS was evaluated in patients withavailable post-SBRT imaging follow-up. Survival analysis was performed using theKaplan–Meier method with log-rank testing, and multivariate Cox regression wasused to calculate adjusted hazard ratios (AHR) with 95% confidence intervals (CI).Results: Of 183 registered patients, 65 met the inclusion criteria (ALBI grade 1:31/65 [47.7%]; grade 2: 30/65 [46.2%]; grade 3: 4/65 [6.2%]). There were 42deaths (64.6%). The median OS for ALBI grades 1, 2, and 3 was 54.0 months, 19.0months (95% CI 10.30–27.70), and 5.0 months (95% CI 1.08–8.92), respectively(log-rank p=0.003). In multivariate analysis, each one-grade increase in ALBI wasassociated with a significantly higher hazard of death (AHR 1.801; p=0.021). ForPFS analysis, 45 patients were eligible (29 progressions; 64.4%). Median PFS forALBI grades 1, 2, and 3 was 11.0 months (95% CI 2.37–19.63), 4.0 months (95%CI 1.80–6.20), and 1.0 month, respectively (log-rank p < 0.001). ALBI grade was anindependent predictor of disease progression (AHR 2.569; p=0.027).Conclusion: ALBI grade demonstrates a graded association with decreased OSand PFS and serves as an independent prognostic factor in HCC patientsundergoing SBRT at RSCM.
Keywords: hepatocellular carcinoma, stereotactic body radiotherapy, ALBI score,Child–Pugh, overall survival, progression-free survival.