Incorporating albumin–bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma

Chan, Anthony W.H.; Chong, Charing Ching‐Ning; Mo, Frankie; Wong, John; Park, Yeon Hee; Johnson, Philip J.; Yu, Simon C.H.; Lai, Paul; To, Ka‐Fai; Chan, Stephen L.

doi:10.1111/jgh.13457

Cited by 47 publications

(33 citation statements)

References 32 publications

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“…Additionally, albumin, as part of the ALBI grading system, has been shown to be a quantitative, useful and prognostic indicator of liver dysfunction in HCC patients (21)(22)(23)(24)(25). Albumin has previously been reported to have direct HCC growth inhibitory properties in vitro (26,27), and there is also suggestive clinical evidence for an inhibitory effect on HCC in patients (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma Patients

Carr

Guerra

2017

Int J Biol Markers

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ORIGINAL RESEARCH ARTICLEFurthermore, albumin values have been used in the 2-parameter albumin-bilirubin (ALBI) quantitative grading system for liver function in HCC, which has in turn been incorporated into several staging systems (21-25). There is thus much recent interest in serum albumin levels in prognostication, mainly as a reflection of liver function in HCC. However, there is also some direct experimental evidence that increased albumin levels can actually suppress HCC cell growth (26,27). Viewed this way, albumin levels may influence prognosis as much by their actions on HCC biology as by their reflection of impaired liver function.In this study, we examined the clinical correlations of serum albumin levels in a large HCC patient cohort with parameters of HCC behavior, and found an inverse relationship between serum albumin levels and HCC aggressiveness. Methods Patient dataWe retrospectively analyzed a prospectively collected database of 4,139 HCC patients, as previously reported (28,29), who had full baseline tumor parameter data, including computed axial tomography (CT) scan information on HCC size, number of tumor nodules and presence of PVT and plasma AFP levels; complete blood counts; routine blood liver function tests (total bilirubin, γ-glutamyl transpeptidase [GGT] and albumin); and patient demographics. Database management conformed to legislation on privacy, and this study conformed to the ethical guidelines of the Declaration of Helsinki. Approval for this retrospective study

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Section: Discussionmentioning

confidence: 99%

Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma Patients

Carr

Guerra

2017

Int J Biol Markers

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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Background/Aim: Recently, albumin-bilirubin (ALBI) scoring/grading, consisting of only albumin and total bilirubin, has been proposed. We examined the efficacy of this grading system for determining hepatic function in patients with hepatocellular carcinoma (HCC). Methods/Materials: The prognoses of 46,681 HCC patients based on results obtained from a nationwide survey conducted in Japan from 2001 to 2007 were evaluated using (1) Japan Integrated Staging (JIS), consisting of Child-Pugh classification and TNM staging (TNM), (2) modified JIS (m-JIS), consisting of liver damage grading and TNM, and (3) ALBI-TNM (ALBI-T), consisting of ALBI grading and TNM, and the results were compared. A subanalysis was also performed to define a cutoff value for ALBI scores for a more detailed stratification of hepatic function. Results: ALBI-T, JIS, and m-JIS each showed good capacity for the stratification of prognoses. Although the Akaike information criterion for ALBI-T was nearly equal to that for JIS and m-JIS, the Kaplan-Meier curves and median survival times obtained with ALBI-T were always superior to the corresponding scores. When the indocyanine green retention test (<30%) was used as an additional cutoff value for ALBI score (-2.270, area under the curve 0.828) to divide ALBI grade into 4 levels (modified ALBI [mALBI] grade), mALBI grade was able to stratify the prognosis of patients at any TNM stage in order of grade. Modified ALBI-T (mALBI-T), using mALBI grading and TNM, produced a more detailed stratification for prognosis. Conclusion: The predictive value for prognosis of ALBI-T was found to be equal to that of JIS and m-JIS. In addition, mALBI grading and mALBI-T, as proposed in the present study, might provide a more detailed assessment of the hepatic function and prognosis of HCC patients.

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“…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] .…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Aim/Background: The purpose of this study was to evaluate the validity of 3 classifications for assessing liver function, the liver damage and Child-Pugh classifications and the newly proposed albumin-bilirubin (ALBI) grade, in order to examine the feasibility of evaluating hepatic function using ALBI grade with the hepatocellular carcinoma (HCC) treatment algorithm used in Japan. Methods: We analyzed the medical records of 3,495 Japanese HCC patients admitted from 2000 to 2015, which were comprised of 1,580 patients hospitalized in the Ehime Prefecture area and used as a training cohort (Ehime group), and 1,915 others who were used for validation (validation group). ALBI score used for grading ( ≤ -2.60 = grade 1, greater than -2.60 to ≤ -1.39 = grade 2, greater than -1.39 = grade 3) as well as clinical features and prognosis (Japan Integrated Staging [JIS], modified JIS, ALBI-TNM [ALBI-T] score) were retrospectively investigated. Results: For prediction of liver damage A, the values for sensitivity and specificity, positive predictive and negative predictive values, and positive and negative likelihood ratios of ALBI-1 and Child-Pugh A were similar among the 2 groups. Akaike information criterion results showed that prognosis based on ALBI grade/ALBI-T score was better than that based on liver damage/modified JIS score and Child-Pugh/JIS score (22,291.8/21,989.4, 22,379.6/22,076.0, 22,392.1/22,075.1, respectively). The cutoff values for ALBI score for indocyanine green retention rate at 15 min (ICG-R15) <10, <20, and <30% were -2.623 (area under the curve [AUC]: 0.798), -2.470 (AUC: 0.791), and -2.222 (AUC: 0.843), respectively. The distribution of ICG-R15 (<10%, 10 to <20%, 20 to <30%, and ≥ 30%) for ALBI grade 1 was similar to that for liver damage A. There were only small differences with regard to therapeutic selection with the Japanese HCC treatment algorithm between liver damage and ALBI grade. Conclusion: ALBI grade is a useful and easy classification system for assessment of hepatic function for therapeutic decision making.

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Incorporating albumin–bilirubin grade into the cancer of the liver Italian program system for hepatocellular carcinoma

Abstract: The ALBI grade performs as well as the CP grade when integrating into the CLIP system. ALBI-CLIP and CP-CLIP systems are the most accurate prognostic models among 11 existing staging systems.

Cited by 47 publications

References 32 publications

Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma Patients

Serum Albumin Levels in Relation to Tumor Parameters in Hepatocellular Carcinoma 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

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

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