Assessment of the Albumin-Bilirubin (ALBI) Grade as a Prognostic Indicator for Hepatocellular Carcinoma Patients Treated With Radioembolization

Abstract

Objective As the utility of Child-Pugh (C-P) class is limited by the subjectivity of ascites and encephalopathy, we evaluated a previously established objective method, the albumin-bilirubin (ALBI) grade, as a prognosticator for yttrium-90 radioembolization (RE) treatment for patients with hepatocellular carcinoma (HCC). Materials and Methods A total of 117 patients who received RE for HCC from 2 academic centers were reviewed and stratified by ALBI grade, C-P class, and Barcelona Clinic Liver Cancer stage. The overall survival (OS) according to these 3 criteria was evaluated by Kaplan-Meier survival analysis. The utilities of C-P class and ALBI grade as prognostic indicators were compared using the log-rank test. Multivariate Cox regression analysis was performed to identify additional predictive factors. Results Patients with ALBI grade 1 (n = 49) had superior OS than those with ALBI grade 2 (n = 65) (P = 0.01). Meanwhile, no significant difference was observed in OS between C-P class A (n = 100) and C-P class B (n = 14) (P = 0.11). For C-P class A patients, the ALBI grade (1 vs. 2) was able to stratify 2 clear and nonoverlapping subgroups with differing OS curves (P = 0.03). Multivariate Cox regression test identified alanine transaminase, Barcelona Clinic Liver Cancer stage, and ALBI grade as the strongest prognostic factors for OS (P < 0.10). Conclusions ALBI grade as a prognosticator has demonstrated clear survival discrimination that is superior to C-P class among HCC patients treated with RE, particularly within the subgroup of C-P class A patients. ALBI grade is useful for clinicians to make decisions as to whether RE should be recommended to patients with HCC.

Differences in the impact of prognostic factors for hepatocellular carcinoma over time

“…We used the ALBI score as an indicator of liver function. Although we found a significant correlation between Child-Pugh class and ALBI score and several recent studies have reported that ALBI score is a good indicator of liver function, (9)(10)(11)(28)(29)(30)(31) further verification of ALBI score as a measure of liver function is required. When patients were categorized based on tumor markers or liver fibrosis markers, the cut-offs were fixed as the median for each value.…”

Visceral Adipose Tissue Radiodensity Is Linked to Prognosis in Hepatocellular Carcinoma Patients Treated with Selective Internal Radiation Therapy

“…Various factors, such as size and number of tumors, liver function, and body composition features have been linked to the prognosis of patients with HCC [2,5]. With regard to other predictive tests, the albumin-bilirubin (ALBI) grade demonstrates superiority to Child-Pugh in predicting the survival of HCC patients treated with radioembolization [6]. However, ALBI alone does not include other prognostic factors such as patient performance status and tumor burden.…”

Preoperative platelet-albumin–bilirubin grades predict the prognosis of patients with hepatitis B virus-related hepatocellular carcinoma after liver resection

“…[ 5 ] Since it was introduced, a number of investigations have confirmed that the ALBI grade was better than the Child–Pugh score in predicting a patient's liver function as well as in predicting a patient's prognosis following liver resection and radioembolization. [ 3 , 6 , 7 ] However, the ALBI grade does not incorporate portal hypertension, which is considered to be an unfavorable factor for long-term survival of HCC patients. [ 8 , 9 ] Recently, based on the ALBI grade, the platelet-albumin–bilirubin (PALBI) grade was developed to assess a patient's liver function.…”