Perioperative and prognostic implication of albumin‐bilirubin‐TNM score in Child‐Pugh class A hepatocellular carcinoma

Abstract

Background and AimA reliable classification for predicting postoperative prognosis and perioperative risk of hepatocellular carcinoma (HCC) patients is required to make a precise decision for HCC treatment. In the present study, we assessed the perioperative and prognostic importance of indocyanine green (ICG) testing, tumor‐node‐metastasis (TNM) stage, albumin‐bilirubin (ALBI) grade, and ALBI‐TNM (ALBI‐T) score using consecutive resected HCC cases.MethodsBetween 1998 and 2011, 273 consecutive patients who underwent primary and curative hepatectomy for HCC were identified. Among these 273 cases, 235 Child‐Pugh class A patients were enrolled in the present study.ResultsCorrelation analysis showed that the value of linear predictor for ALBI grade was significantly correlated with ICG 15‐minute retention rates (r = 0.51, P < 0.0001). Survival analysis for both recurrence‐free survival (RFS) and overall survival (OS) showed there were significant differences between the two groups stratified by stage or ALBI‐T score (stage, RFS: P = 0.01, OS: P = 0.003; ALBI‐T, RFS: P < 0.0001, OS: P < 0.0001). In addition, Cox proportional hazard model identified ALBI‐T score was a significant predictor for both RFS and OS (RFS, P = 0.001; OS, P = 0.004). Furthermore, ALBI‐T score could predict perioperative risk in hepatectomy such as longer operation time and excessive intraoperative blood loss.ConclusionsThis study showed a robust association of ALBI‐T score with postoperative HCC patient survival and perioperative risk in hepatectomy. ALBI‐T score can be used as a simple and powerful tool for assessing HCC patients with further study.

Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

“…The score has been validated in hepatic and nonhepatic, elective, and emergency surgeries for short-term as well as long-term outcome prediction [23][24][25]. There is enough evidence that elective surgery is safe and feasible in patients with Child-Pugh class A cirrhosis who have preserved liver function [26,27]. Child-Pugh class B and C patients are at high risk of perioperative outcomes, and some authors consider this as a relative contraindication to surgery.…”

“…Child-Pugh class B and C patients are at high risk of perioperative outcomes, and some authors consider this as a relative contraindication to surgery. In a study including 273 patients, Sonohara et al [26] reported clinical data on 235 patients who were all Child-Pugh class A. In a multicenter study including 253 patients with Child-Pugh class B cirrhosis from 14 international centers, Berardi et al [28] have shown that postoperative morbidity following HR in these patients remains high (42.7%).…”

Comparison of non‐invasive liver reserve and fibrosis models: Implications for surgery and prognosis for hepatocellular carcinoma

“…22 The ALBI grade was proposed as a simple and objective method for assessment of liver function in HCC as a result of an international collaborative study. 23 Although ALBI grade has been validated externally in several other studies, 7,8,24,25 it does not incorporate portal hypertension or liver fibrosis. Therefore, blood platelet count was introduced as a surrogate marker of portal hypertension to develop the PALBI grade.…”

“…We previously reported a robust association of albumin–bilirubin and tumor–node–metastasis (TNM) score with perioperative risks and postoperative patient survival . A recent model for hepatic functional reserve based on albumin–bilirubin (ALBI) grade, platelet–albumin–bilirubin (PALBI) grade, can be potentially used to evaluate liver fibrosis status as well as hepatic reserves because the model includes a platelet component, which is an established indicator for liver fibrosis.…”

“…We previously reported a robust association of albumin-bilirubin and tumor-node-metastasis (TNM) score with perioperative risks and postoperative patient survival. 7 A recent model for hepatic functional reserve based on albumin-bilirubin (ALBI) grade, platelet-albumin-bilirubin (PALBI) grade, 8 can be potentially used to evaluate liver fibrosis status as well as hepatic reserves because the model includes a platelet component, which is an established indicator for liver fibrosis. In addition, although the current gold standard for diagnosing and staging liver fibrosis is liver biopsy, evidence is accumulating for use of non-invasive liver fibrosis biomarkers and models for diagnosing fibrosis status including fibrosis index based on four factors (FIB-4) 9,10 and aspartate transaminase-to-platelet ratio index (APRI) to inform both patients and clinicians.…”