ALBI Score Is a Strong Predictor of Toxicity Following SIRT for Hepatocellular Carcinoma

Abstract

Background: Selective internal radiation therapy (SIRT) is an innovative treatment of hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score was designed to better evaluate liver functions in HCC. Methods: We studied, retrospectively, data from patients treated with SIRT for HCC. The primary endpoint was the occurrence of radioembolization-induced liver disease (REILD). The secondary endpoint was overall survival (OS). Results: 222 patients were studied. The ALBI grade 1 patients had significantly less REILD (3.4%) after the first SIRT than ALBI grade 2 or 3 patients (16.8%, p = 0.002). Of the 207 patients with data, 77 (37.2%) had a worsening of ALBI grade after one SIRT. The baseline ALBI grade was significantly associated with OS (p = 0.001), also in the multivariable analysis. The ALBI grade after the first SIRT was significantly associated with OS (p ≤ 0.001), with median OS of 26.4 months (CI 95% 18.2–34.7) for ALBI grade 1 patients (n = 48) versus 17.3 months (CI 95% 12.9–21.8) for ALBI grade 2 patients (n = 123) and 8.1 months (CI 95% 4.1–12.1) for ALBI grade 3 patients (n = 36). Conclusions: The baseline ALBI grade is a strong predictor of REILD. The baseline ALBI score and variations of ALBI are prognostic after SIRT.

Breaking the Child-Pugh Dogma in Hepatocellular Carcinoma

“…26 There is increasing evidence that not only can ALBI predict survival after therapy 16,27,28 but it may also be associated with improved outcomes in modern systemic therapies for advanced HCC, including lenvatinib, 29,30 immunotherapy, 31 and selective internal radiation therapy/transarterial chemoembolization where it may aid identification of toxicity posttreatment. 32,33 Indeed, classification of hepatotoxicity in patients with HCC is unsatisfactory, and criteria such as ALT/AST elevation seem to be poor measures of safety in HCC. 34 CP-A versus B classification is prognostic but does not identify patients who suffer from increased toxicity to sorafenib.…”

LiMAx Prior to Radioembolization for Hepatocellular Carcinoma as an Additional Tool for Patient Selection in Patients with Liver Cirrhosis

“…This score notably facilitates an additional risk stratification within the Child–Pugh score A population [ 29 ]. In a retrospective analysis, patients with Child–Pugh score A and ALBI grade 2 were at substantially higher mortality risk due to hepatic dysfunction after RE than patients with ALBI grade 1 [ 30 ]. Previous studies confirmed ALBI score as a helpful predictor of hepatic deterioration after RE [ 30 , 31 ].…”

“…In a retrospective analysis, patients with Child–Pugh score A and ALBI grade 2 were at substantially higher mortality risk due to hepatic dysfunction after RE than patients with ALBI grade 1 [ 30 ]. Previous studies confirmed ALBI score as a helpful predictor of hepatic deterioration after RE [ 30 , 31 ]. However, it still harbors several pitfalls in tumor patients, such as inflammation and malnutrition, that can undoubtedly influence relevant parameters such as albumin as an integral part of those scores.…”

Radiofrequency Ablation versus Transarterial Chemoembolization for Hepatocellular Carcinoma within Milan Criteria: Prognostic Role of Tumor Burden Score

“…The cut-off values of ALBI grade 1/grade 2 and ALBI grade 2/grade 3 were −2.60 and −1.39, respectively [ 20 , 21 , 22 ].…”