Proposed New Sub-Grouping for Intermediate-Stage Hepatocellular Carcinoma Using Albumin-Bilirubin Grade

Abstract

Aim: We retrospectively evaluated the efficacy of albumin-bilirubin (ALBI) grade, which has been proposed as a new classification for hepatic function, for evaluation of the prognosis of intermediate-stage hepatocellular carcinoma (Barcelona Clinic Liver Cancer criteria stage B, BCLC-B). Patients and Methods: We enrolled 754 naïve BCLC-B patients (multiple tumors) and retrospectively analyzed their clinical features [surgical resection (hepatectomy), n = 170; radiofrequency ablation (RFA), n = 110; percutaneous ethanol injection, n = 7; transcatheter arterial chemoembolization, n = 396; others, n = 25; best supportive care, n = 46]. Four sub-groups were defined for the Modified Intermediate Stage of Liver Cancer (MICAN) criteria as follows: B1 (ALBI-1/within up-to-7 criteria), B2 (ALBI-2/within up-to-7 criteria), B3 (ALBI-1 and ALBI-2/multiple and beyond up-to-7 criteria), and B4 (ALBI-3/any). Results: The median survival time of patients classified as B1 (n = 94), B2 (n = 175), B3 (n = 452), and B4 (n = 33) was 65.1, 48.1, 29.6, and 14.6 months, respectively (p < 0.01 for each). Those in B1 treated with hepatectomy and RFA comprised 67.0%, while that ratio was 51.4% in B2, 28.3% in B3, and 12.1% in B4. Conclusion: The MICAN criteria based on ALBI grade are simple and useful for prediction of prognosis and therapy decision-making in the heterogeneous population of BCLC-B patients.

Validation and Potential of Albumin-Bilirubin Grade and Prognostication in a Nationwide Survey of 46,681 Hepatocellular Carcinoma Patients in Japan: The Need for a More Detailed Evaluation of Hepatic Function

“…In addition, because of the progress in techniques used for imaging, and therapeutic assistant modalities for the diagnosis and treatment of HCC (virtual ultrasonography [39], artificial effusion [40], contrast-enhanced ultrasonography [41,42], and Gd-EOB-DTPA-enhanced MRI [43,44]), the frequencies of resection and ablative therapies including radiofrequency ablation will increase; thus, a more suitable hepatic function assessment tool for the recent trend in Japanese HCC is needed. In addition to the usefulness of ALBI-T for Japanese patients, that of modified CLIP scoring [45], modified BCLC (Barcelona Clinic Liver Cancer) staging [46], and BCLC-B substaging using ALBI grading instead of the Child-Pugh classification/scoring system [47] has recently been reported. Thus, the simply calculated ALBI grade can play an important role in the assessment of hepatic function not only in the recent trend of Japanese HCC but also worldwide.…”

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

“…Omagari et al [8] reported that the liver damage classification is a more effective evaluation method for patients with early stage HCC as compared to the Child-Pugh classification. Recently, a simple evaluation method for hepatic function, termed albumin-bilirubin (ALBI) grade, which is calculated using only serum albumin and total bilirubin, has been proposed [9] , and some have reported its usefulness for HCC treatment planning [9][10][11][12][13][14][15][16] .…”

Combination of Resection and Ablative Treatment for Hepatocellular Carcinoma: Usefulness of Complementary Radiofrequency Ablation

“…In general, TACE is recommended as standard therapy for intermediate-stage cases (Barcelona Clinic Liver Cancer [BCLC]-B stage) [34, 35]. Recent reports have proposed subgrading of BCLC-B [36-38], as there may be some BCLC-B patients who would receive survival benefit from curative treatment. Hirooka et al [39] reported that RFA can be effective for BCLC-B1 and B2, while Tada et al [40] noted that some of their BCLC-B HCC patients (Child-Pugh score 5 and ≤3 tumors) received a therapeutic benefit by undergoing surgical resection.…”