Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications

Abstract

Aim/Background: The purpose of this study was to evaluate the validity of 3 classifications for assessing liver function, the liver damage and Child-Pugh classifications and the newly proposed albumin-bilirubin (ALBI) grade, in order to examine the feasibility of evaluating hepatic function using ALBI grade with the hepatocellular carcinoma (HCC) treatment algorithm used in Japan. Methods: We analyzed the medical records of 3,495 Japanese HCC patients admitted from 2000 to 2015, which were comprised of 1,580 patients hospitalized in the Ehime Prefecture area and used as a training cohort (Ehime group), and 1,915 others who were used for validation (validation group). ALBI score used for grading ( ≤ -2.60 = grade 1, greater than -2.60 to ≤ -1.39 = grade 2, greater than -1.39 = grade 3) as well as clinical features and prognosis (Japan Integrated Staging [JIS], modified JIS, ALBI-TNM [ALBI-T] score) were retrospectively investigated. Results: For prediction of liver damage A, the values for sensitivity and specificity, positive predictive and negative predictive values, and positive and negative likelihood ratios of ALBI-1 and Child-Pugh A were similar among the 2 groups. Akaike information criterion results showed that prognosis based on ALBI grade/ALBI-T score was better than that based on liver damage/modified JIS score and Child-Pugh/JIS score (22,291.8/21,989.4, 22,379.6/22,076.0, 22,392.1/22,075.1, respectively). The cutoff values for ALBI score for indocyanine green retention rate at 15 min (ICG-R15) <10, <20, and <30% were -2.623 (area under the curve [AUC]: 0.798), -2.470 (AUC: 0.791), and -2.222 (AUC: 0.843), respectively. The distribution of ICG-R15 (<10%, 10 to <20%, 20 to <30%, and ≥ 30%) for ALBI grade 1 was similar to that for liver damage A. There were only small differences with regard to therapeutic selection with the Japanese HCC treatment algorithm between liver damage and ALBI grade. Conclusion: ALBI grade is a useful and easy classification system for assessment of hepatic function for therapeutic decision making.

Albumin-Bilirubin Grade and Hepatocellular Carcinoma Treatment Algorithm

“…Consistent with previous studies, Hiraoka et al [26] showed that the ALBI grade was superior to the Child-Pugh classification. They also found that the ALBI grade can assess hepatic functional reserve with comparable efficacy to the liver damage grade.…”

“…Hiraoka et al [26] performed the first study comparing the ALBI grade with the LCSGJ liver damage grade, and the results were reported in this issue of Liver Cancer . Consistent with previous studies, Hiraoka et al [26] showed that the ALBI grade was superior to the Child-Pugh classification.…”

“…Based on the Makuuchi criteria, patient cohorts with an ICG R15 <10, 10-19, and 20-30% are considered candidates for two-segmentectomy, segmentectomy, and subsegmentectomy, respectively. Although the ICG R15 is an important factor for determining the resectable area, Hiraoka et al [26] found that the ALBI score can also be used to identify groups corresponding to such ranges of ICG R15 values. Specifically, they found that the ALBI score for predicting an ICG R15 of <10% was -2.623 (AUC, 0.798), the ALBI score for predicting an ICG R15 of 10-20% was -2.470 (AUC, 0.791), and the ALBI score for predicting an ICG R15 of 20-30% was -2.222 (AUC, 0.843).…”

“…However, this is essentially a double standard, which is undesirable for clinical practice guidelines. Hiraoka et al [26] proposed that the ALBI grade is a better measure to address this issue because the score is highly accurate for both nonsurgical and surgical treatments. This is a reasonable and clear-cut message.…”

ALBI Score as a Novel Tool in Staging and Treatment Planning for Hepatocellular Carcinoma: Is It Sufficient

“…We read the paper “Albumin-bilirubin (ALBI) grade as part of the evidence-based clinical practice guideline for HCC of the Japan Society of Hepatology: A comparison with the liver damage and Child-Pugh classifications”, published in a recent issue of Liver Cancer [1], with interest. In this multicenter study including 3,495 patients with hepatocellular carcinoma (HCC) undergoing different therapies, the authors show that the ALBI grade can be used as a marker of liver functional reserve in HCC patients from different geographical regions in Japan.…”