BALAD and BALAD-2 predict survival of hepatocellular carcinoma patients: a North American cohort study

Nicha Wongjarupong, Gabriela M. Negron-Ocasio, Kristin C. Mara, Kritika Prasai, Mohamed A. Abdallah, Keun Soo Ahn, Ju Dong Yang, Benyam D. Addissie, Nasra H. Giama, William S. Harmsen, Terry M. Therneau, Lewis R. Roberts

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The BALAD score and BALAD-2 class derived from bilirubin, albumin, AFP, AFP-L3, and des-gamma-carboxyprothrombin (DCP) are effective in predicting mortality in HCC, but have not been validated in North America. Methods: 148 HCC patients from 2000 to 2015 who had all five biomarkers tested at diagnosis were included. Hazard ratios (HR) were calculated. Results: 75 patients died during a median follow-up of 21.9 months. 1-and 3-year survival rates were 70.8% and 47.6%. 114 (77%) had cirrhosis. The HR (95%CI) for death were 1.24 (0.42–3.67), 1.79 (0.61–5.26), 2.83 (0.95–8.38), and 7.19 (2.26–22.91) for BALAD scores 1, 2, 3, and 4 vs. BALAD 0. The HR (95%CI) for death were 1.25 (0.65–2.40), 1.75 (0.94–3.23), and 6.20 (3.29–11.68) for BALAD-2 classes 2, 3, and 4 vs. BALAD-2 class 1. A multivariate model incorporating maximal tumor diameter, tumor number, neutrophil-lymphocyte ratio, and BALAD had HR of 1.43 (1.14–1.81) per increase of 1 BALAD score. A similar model with BALAD-2 had HR of 1.50 (1.18–1.90) per increase of 1 BALAD-2 class. Conclusion: BALAD models at diagnosis can predict the survival of HCC patients in North America. AFP, AFP-L3, and DCP reflect tumor progression and metastasis of HCC and distinguish the BALAD model from other predictive models.

Original languageEnglish (US)
Pages (from-to)762-769
Number of pages8
Issue number5
StatePublished - May 2021

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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