Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma

Abstract

BACKGROUND An ideal staging system for hepatocellular carcinoma (HCC) should rely on the hepatic reserve function and tumor burden. With the improvement in diagnostic and treatment strategies for HCC, in addition to recent treatment of viral hepatitis, finding a suitable assessment tool for hepatic reserve has become mandatory. AIM To validate a recently proposed modified albumin-bilirubin-TNM (mALBI-T) grade as a prognostic model for patients with HCC in Egypt. METHODS For patients diagnosed with HCC, Child-Turcotte-Pugh (CTP) score, Barcelona Clinic Liver Cancer (BCLC) stage, albumin-bilirubin (ALBI), plateltet-albumin–bilirubin (PALBI), ALBI-based BCLC, ALBI-T and mALBI-T grades were estimated. Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive. Overall survival and received treatments were determined. Survival data were analyzed. RESULTS A total of 1910 patients were included (mean age, 57 years; 1575 males). At presentation, 50.6% had CTP A, 36.1% had CTP B and 13.4 % had CTP C; 12% had ALBI grade 1, 62.3% had ALBI grade 2 and 24.7% had ALBI grade 3. Overall median survival was 13 mo; survival was better in patients with ALBI 1 than in those with ALBI 2 and 3 (28.6 vs 14 and 5.8 mo, respectively, P < 0.001). Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2, 3, 4 and 5 ( P < 0.001). The modified ALBI-T showed better stratification and significant improvement in prediction of survival. CONCLUSION ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage. mALBI-T is a better prognostic model in patients with HCC.

Comparison of albumin-bilirubin grade, platelet-albumin-bilirubin grade and Child-Turcotte-Pugh class for prediction of survival in patients with large hepatocellular carcinoma after transarterial chemoembolization combined with microwave ablation

“…In our study, we found that PALBI grade was superior to ALBI grade and CTP class in predicting OS of patients with large HCCs after TACE-MWA. These findings are consistent with those of previous studies [30,38]. The CTP classification was originally developed to assess hepatic function in patients with hepatic cirrhosis.…”

“…The PALBI score was calculated using the following equation: PALBI score ¼ 2.02 Â log 10 bilirubin À 0.37 Â (log 10 bilirubin) 2 À 0.04 Â albumin À 3.48 Â log 10 platelets þ 1.01 Â (log 10 platelets) 2 . The PALBI grade was defined as follows: grade 1 (PALBI score À2.53); grade 2 (-2.53 < PALBI score -2.09); and grade 3 (PALBI score >-2.09) [30,33].…”

“…The ALBI grade incorporates two laboratory parametersserum albumin and bilirubin concentrationand can provide a simple and objective method for assessing hepatic function with good prognostic performance in patients with HCC [26][27][28][29]. Based on the ALBI grade, the platelet-ALBI (PALBI) grade was recently developed to account for the effect of portal hypertension, with platelet count acting as a surrogate for the severity of portal hypertension [28,30]. Previous studies have validated ALBI and PALBI grades as significant predictors of OS in HCC patients who underwent surgical resection, RFA, TACE or sorafenib therapy [26,28,30,31].…”

“…Based on the ALBI grade, the platelet-ALBI (PALBI) grade was recently developed to account for the effect of portal hypertension, with platelet count acting as a surrogate for the severity of portal hypertension [28,30]. Previous studies have validated ALBI and PALBI grades as significant predictors of OS in HCC patients who underwent surgical resection, RFA, TACE or sorafenib therapy [26,28,30,31].…”

Prediction of minimal encephalopathy in patients with HCV-related cirrhosis using albumin-bilirubin, platelets-albumin-bilirubin score, albumin-bilirubin-platelets grade and ammonia level

“…ALBI, [7] PALBI [8] and ALBI-PLT [9] are models for assessment of the liver condition without subjective bias. They are based on routine simple investigations.…”