Objective: This study aimed to investigate the prognostic value of preoperative myosteatosis and the albumin–bilirubin (ALBI) grade in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) and develop a robust prognostic score based on these factors. Methods: Patients with HCC who underwent TACE between January 2009 and December 2020 were included. Multivariate Cox regression analysis identified prognostic factors. CT-based body composition parameters were acquired from baseline abdominal CT images at the level of the third lumbar vertebra. A prognostic score (Myo-ALBI) was developed based on the presence of preoperative myosteatosis and the ALBI grade, and its prognostic value was evaluated. Results: Of 446 patients, 63% were male, and the mean age was 62.4 years. Preoperative myosteatosis was present in 41.5% of patients. The BCLC stages were mostly B (67.9%). Multivariate analysis shows that preoperative myosteatosis, ALBI grade 2, and ALBI grade 3 were independent prognostic factors. The Myo-ALBI grade was incorporated into a prognostic model, including alpha-fetoprotein and up-to-seven criteria, to generate a nomogram. The C-index of the nomogram based on the Myo-ALBI grade (0.743) was significantly higher than the non-Myo-ALBI nomogram (0.677), the up-to-seven criteria (0.653), the ALBI grade (0.616), and the Child–Pugh class (0.573) (allp< 0.05). The t-ROC curve for the nomogram was consistently superior to the other models throughout the observation period in all patients and the BCLC-B subgroup. Conclusions: The combination of preoperative CT-derived myosteatosis and ALBI grade enhances prognostication for patients with unresectable HCC undergoing TACE. The Myo-ALBI nomogram constructed in this study could support individualized prognosis prediction, assisting in treatment decision-making for HCC patients.
目的：本研究旨在探讨术前肌肉脂肪变性与白蛋白-胆红素（ALBI）分级对接受经动脉化疗栓塞（TACE）治疗的肝细胞癌（HCC）患者的预后价值，并基于这些因素构建一个稳健的预后评分系统。方法：纳入2009年1月至2020年12月期间接受TACE治疗的HCC患者。通过多变量Cox回归分析确定预后因素。基于CT的身体成分参数从基线腹部CT图像在第三腰椎水平获取。根据术前肌肉脂肪变性的存在与否及ALBI分级构建预后评分（Myo-ALBI），并评估其预后价值。结果：在446例患者中，63%为男性，平均年龄62.4岁。41.5%的患者存在术前肌肉脂肪变性。BCLC分期主要为B期（67.9%）。多变量分析显示，术前肌肉脂肪变性、ALBI 2级和ALBI 3级是独立的预后因素。将Myo-ALBI分级纳入包含甲胎蛋白和"up-to-seven"标准的预后模型中，构建了列线图。基于Myo-ALBI分级的列线图C指数（0.743）显著高于非Myo-ALBI列线图（0.677）、"up-to-seven"标准（0.653）、ALBI分级（0.616）和Child-Pugh分级（0.573）（所有p < 0.05）。在所有患者及BCLC-B亚组中，该列线图的t-ROC曲线在整个观察期内始终优于其他模型。结论：术前CT评估的肌肉脂肪变性与ALBI分级相结合，可增强对接受TACE治疗不可切除HCC患者的预后评估。本研究构建的Myo-ALBI列线图有助于支持个体化预后预测，辅助HCC患者的治疗决策。
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