Easy albumin–bilirubin score as a new prognostic predictor in hepatocellular carcinoma

Abstract

Background: Liver functional reserve is a major prognostic determinant in patients with hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score is an objective method to assess the severity of cirrhosis in this setting. However, calculation of the ALBI score is complex and difficult to access in clinical practice.Recently, the EZ (easy)-ALBI score was proposed as an alternative biomarker of liver injury. We aimed to evaluate the prognostic role of the EZ-ALBI score in HCC from early to advanced stages.Methods: A total of 3794 newly diagnosed HCC patients were prospectively enrolled and retrospectively analyzed. Independent prognostic predictors were determined by using the multivariate Cox proportional hazards model. Results:The EZ-ALBI score showed good correlation with the ALBI score (correlation coefficient, 0.965; p < 0.001). The correlation of the EZ-ALBI score was highly preserved in different Child-Turcotte-Pugh (CTP) classifications, treatment methods, and Barcelona Clinic Liver Cancer (BCLC) stages (correlation coefficients, 0.90-0.97). In the Cox multivariate analysis, age >65 years, male sex, serum α-fetoprotein >20 ng/ml, large or multiple tumors, total tumor volume >100 cm 3 , vascular invasion or distant metastasis, ascites, poor performance status, EZ-ALBI grade 2 and 3, and noncurative treatments were independently associated with increased mortality (all p < 0.05). Moreover, EZ-ALBI grade can stratify long-term survival in patients with different CTP class, treatment strategy, and BCLC stage. Conclusions:The EZ-ALBI score is an easy and feasible method to evaluate liver functional reserve. As a new prognostic biomarker in HCC, the predictive power of the EZ-ALBI grade is independent across different cancer stages and treatments.

Validation and Prognostic Value of EZ-ALBI Score in Patients with Intermediate-Stage Hepatocellular Carcinoma Treated with Trans-Arterial Chemoembolization

“…11,25 To avoid the complexity of ALBI calculation, the EZ-ALBI score has been proposed with a good correlation with the conventional ALBI score. In our study, the correlation between the EZ-ALBI and ALBI scores was excellent, with a correlation coe cient of 1.000, which was in line with the studies by Kariyama et al and Ho et al 15,16 The prognostic performance of CTP, MELD, and ALBI scores among patients receiving TACE remains unclear in previous studies. [26][27][28][29] In this study, EZ-ALBI and ALBI scores showed high AUROCs and C-indices, which outperformed other models for anticipating death in this population.…”

“…15 Further, only 27.0% of patients undergoing TACE were enrolled in the Taiwanese validation set and the study reported a median OS of less than 25 months for patients treated with non-curative treatments, which comprised not only TACE but also systemic treatment and best supportive care. 16 With a small proportion of patients treated with TACE in previous studies, it could not make a rm conclusion for the prognostic performance of EZ-ALBI in patients with intermediate-stage HCC, which usually encompasses a highly heterogeneous population. Moreover, unlike the original Japanese cohort, which mainly comprised of patients with HCV infection (58.6%) 15 , the patients in our study had HBV infection as the majority of liver disease.…”

“…15 EZ-ALBI score was signi cantly correlated with the conventional ALBI score and demonstrated good prognostic prediction across all HCC stages. 15,16 With its simplicity, the EZ-ALBI score may potentially replace the ALBI score in clinical practice.…”

Validation and prognostic value of EZ-ALBI score in patients with intermediate-stage hepatocellular carcinoma treated with trans-arterial chemoembolization

“…Therefore, an easy albumin-bilirubin (EZ-ALBI) score, a simplified and user-friendly formula for the ALBI score, has been developed [ 15 ]. EZ-ALBI score was significantly correlated with the conventional ALBI score and demonstrated good prognostic prediction across all HCC stages [ 15 , 16 ]. With its simplicity, the EZ-ALBI score may potentially replace the ALBI score in clinical practice.…”

Prognostic prediction for patients with hepatocellular carcinoma receiving immunotherapy: Are we there yet?

“…Lastly, most experts in HCC would agree that the ALBI grade (or easy ALBI grade, an updated version of the ALBI grade) should be entered into the Cox model to generate potential prognostic predictors in this kind of study [6,7]. However, this strategy has not been undertaken in the current study, and pivotal clinical predictors could be missed [1].…”