Clinical Role of Newly Developed ALBI and mALBI Grades for Treatment of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of death worldwide. The selection of therapeutic modalities and the prognosis of affected patients are well known to be dependent not only on the tumor burden but also on the hepatic reserve function. Antiviral treatments for chronic hepatitis related to a viral infection and an increase in cases of nonviral HCC associated with the aging of society have resulted in dramatic changes regarding the characteristics of HCC patients. With recent developments in therapeutic modalities for HCC, a more detailed assessment of hepatic function has become an important need. Studies in which the relationship of albumin-bilirubin (ALBI) grade with the prognosis of HCC patients was investigated were reviewed in order to evaluate the usefulness of newly developed ALBI and modified ALBI (mALBI) grades for HCC treatment, as those scoring methods are considered helpful for predicting the prognosis and selecting therapeutic modalities based on the expected prognosis.

99mTc-GSA scintigraphy and modified albumin–bilirubin score can be complementary to ICG for predicting posthepatectomy liver failure

“…Recently, researchers have reported the usefulness of the ALBI score and ALBI grade, calculated from serum albumin and bilirubin, in assessing hepatic function. 23,38,39 The greatest advantage of ALBI is that it can be obtained easily from routine blood test results. ALBI is worse in patients with hyperbilirubinemia, so as with ICG, it is useful for evaluating hepatic functional reserve in patients with low ICG-R15.…”

“…The ALBI score was calculated as − 0.085 × (albumin [g/L]) + 0.66 × log10(− total bilirubin [µmol/L]), and was further categorized into three different grades as the modi ed ALBI grade: grade 1 ( < − 2.60), grade 2a ( > − 2.60 to < − 2.27), grade 2b (≥− 2.27 to ≤− 1.39), and grade 3 ( > − 1.39). 23 The ICG-R15 was the serum ICG level measured 5 minutes after injection of 0.5 mg/kg of ICG. The LHL15 was calculated by [(L15; the radioactivity of the liver at 15 minutes after 99mTc-GSA injection)] / [L15 + (H15; the radioactivity of the heart at 15 minutes after injection)].…”

“…14,17,18 In addition, the ICG test cannot be performed for patients allergic to this uorescent cyanine dye. [19][20][21][22] As an alternative to the ICG test, the ALBI score, a parameter calculated from albumin and total bilirubin in the blood; the ALBI grade; 13 and the modi ed ALBI (mALBI) grade 23 are also available as preoperative hepatic function tests. In contrast, liver activity at 15 minutes as assessed by 99mTc-GSA scintigraphy (LHL15) has not been used as commonly as ICG-R15 or ALBI due to its high cost and requirement for radioactive agents.…”

Using AI and Gd-EOB-DTPA-enhanced MR imaging to assess liver function, comparing the MELIF score with the ALBI score

“…Both of these clinical guidelines have incorporated the ALBI scoring system as an important component in their latest version 29 – 31 . There is growing evidence in clinical practice that the ALBI score/grade is more appropriate than the MELD or CP score 16 , 32 , 33 . Using 2099 data points from HCC patients in a retrospective study, the ALBI grade showed better prognostic performance than that of CP grade in a survival analysis, as well as a better grade distribution 34 .…”