Prognostic Value of Albumin-Bilirubin Grade (ALBI) in Patients Underwent Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma

Abstract

Aim: We aimed at determining the prognostic value of the albumin–bilirubin grade (ALBI) in patients undergoing transarterial Chemoembolization for unresectable Hepatocellular carcinoma. Background: Various noninvasive liver reserve markers are used to predict the severity of liver injury. The role and probability of these markers in predicting the prognosis of patients with hepatocellular carcinoma (HCC) is still unknown. Methods: Patients who underwent TACE from 2013 to 2017 were included. Patient’s age, gender, cause of cirrhosis, ALBI Grade along with the site, size and number of tumors were recorded. Radiological response to TACE was assessed by CT scan at 1 and 3 months after the procedure, respectively. Survival assessment was performed and all patients were assessed for survival until the last follow-up. Results: A total of 71 patients were included. Majority of them were male (80.3 %). The mean tumor size of 6 ± 3.9 cm. Majority of patients (54.9 %) had a single lesion and it was mostly localized to the right lobe (60.5 %). The most common cause of chronic liver disease was HCV (65.3%). Median Child class score (CTP) and MELD score were 7 and 10, respectively. Ascites was treated prior to TACE in 12 patients (16.9 %). Mean ALBI score in the study population was -1.59 ± 0.69, with the majority (49. 2 %) falling in grade 2. The mean duration of survival at the last follow up was of 12.1 ± 12.14 months (1- 49). Univariate analysis showed serum albumin (p = 0.003), serum bilirubin (p = 0.018), CTP score (p = 0.019), ALBI grade (p = 0.001) and presence of varices (p = 0.04) to be the main predictors of 6 months survival after TACE. On Cox analysis, only ALBI score (p = 0.038) showed statistical significant association. Conclusion: ALBI grade may serve as a surrogate marker in predicting the prognosis of HCC patients undergoing Transarterial Chemoembolization.

Refining Prognosis in Chemoembolization for Hepatocellular Carcinoma: Immunonutrition and Liver Function

“…One recently investigated option is the P-ALBI, combining albumin, bilirubin, and the platelet count. Although Ni et al concluded that the P-ALBI outperforms the ALBI grade alone, the results from Carling et al do not confirm this [27,28]. In our study, a low platelet count was associated with impaired survival (HR = 1.3, 95% CI 0.9-1.7), but without reaching statistical significance in univariate analysis (p = 0.140).…”

“…In addition to a good performance among patients with liver cirrhosis, the ALBI grading was found to be highly predictive in patients with HCC undergoing different treatment approaches [24]. For patients undergoing TACE, the ALBI grade offers an excellent alternative to the CPS [25][26][27][28]. However, stratification based solely on ALBI grading was not found to be superior to other existing scoring systems for predicting median overall survival (OS) in TACE patients [12].…”

The combination of sarcopenia and biochemical factors can predict the survival of hepatocellular carcinoma patients receiving transarterial chemoembolization

“…The current scoring system also possessed other advantages. First, unlike other scores which require logarithmic calculations, our score was simply the summation of six individual scores ( 10 ). Second, the product of our score could be obtained before the administration of first TACE.…”

“…As a result, efforts have been made to evaluate the efficacy of TACE either before or at the beginning of TACE sessions. Many prognostic models were developed to assess the efficiency of TACE, such as the Hepatoma Arterial Embolization Prognostic score (HAP) score, Assessment for Retreatment with TACE (ART) score, Six-and-Twelve prognostic score, Up-to-Seven score, and albumin-bilirubin (ALBI) grade (7)(8)(9)(10)(11)(12)(13)(14)(15). However, most of these models or systems consider only tumor and/or liver factors; few scoring systems to date had incorporated general status of patients such as body composition into consideration.…”

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

“…TACE is recognized worldwide as a standard treatment for BCLC-B HCC, while a few reports have also noted that the ALBI grade is associated with OS in HCC patients treated with TACE. Khalid et al found that only the ALBI grade showed a statistically significant association with OS (HR 3.06, p = 0.038) [37], and Izumoto et al noted that ALBI grade 2 was a significant prognostic factor for worse OS in a study of 192 BCLC-B HCC patients with good hepatic function (Child-Pugh score ≤ 7) (HR 1.548, p = 0.048) [38]. The results of the OPTIMIS trial highlighted the negative influence of TACE on hepatic function as well as the importance of judging TACE failure in clinical practice [39].…”