Prognostic Impact of Albumin-bilirubin (ALBI) Grade on Non-small Lung Cell Carcinoma: A Propensity-score Matched Analysis

Abstract

Background/Aim: Albumin-bilirubin (ALBI) grade is an indicator of liver dysfunction and is useful for predicting postoperative prognosis of hepatocellular carcinomas. However, the significance of ALBI grade in non-small cell lung carcinoma (NSCLC) has not been elucidated. Patients and Methods: We analyzed 947 patients with pStage IA-IIIA NSCLC. We divided patients into ALBI grade 1 and grade 2/3 groups. We then analyzed the association of ABLI grade with clinicopathological characteristics and prognosis in NSCLC by using propensity-score matching. Results: ALBI grade 2/3 was significantly associated with older age, male sex, advanced pT status, and histological type. Even after propensity-score matching, ALBI grade 2/3 patients had significantly worse cancer-specific survival (CSS) than ALBI grade 1 patients (5year CSS: 87.3% versus 92.8%; p=0.0247). In multivariate analysis, ALBI grade 2/3 was an independent predictor of CSS (HR=1.9; p=0.0177). Conclusion: ALBI grade was an independent prognostic factor in surgically resected NSCLC.Non-small cell lung carcinoma (NSCLC) is one of the most lethal neoplasms worldwide (1). Studies to elucidate prognostic factors of surgically resected NSCLC have been conducted to determine appropriate postoperative follow-up and whether adjuvant chemotherapy is required.Albumin-bilirubin (ALBI) grade was first described by Johnson et al. in 2015 as an indicator of liver dysfunction in patients with hepatocellular carcinoma (2). ALBI grade, which is determined using only serum levels of albumin and totalbilirubin, has attracted much attention as a more convenient marker compared with conventional indexes of liver dysfunction such as Child-Pugh score and liver damage grade (2-5). In hepatocellular carcinoma, several studies have demonstrated that ALBI grade is useful for predicting the response to radiofrequency ablation (6), transarterial chemoembolization (7, 8), and molecular targeted therapy (8-10), as well as postoperative prognosis (2,5,6,8,(11)(12)(13). Furthermore, the prognostic value of ALBI grade has also been described in intrahepatic cholangiocarcinomas (14), pancreatic cancer (15), and gastric cancer (16). However, the significance of ALBI grade in NSCLC has not been elucidated.The association of liver function with NSCLC was evaluated in a study that analyzed surgical outcomes of NSCLC with liver cirrhosis and demonstrated that the postoperative mortality of patients with Child-Pugh score B was higher than that of patients with Child-Pugh score A (17). Therefore, liver function may be an important factor in the prognosis of NSCLC. In the present study, we aimed to elucidate the prognostic impact of ALBI grade in surgically resected NSCLC patients. Patients and MethodsPatients. This study was approved by our institutional review board (Kyushu University, Kyushu, Japan, IRB No. 2019-232). One thousand seventeen patients with surgically resected pathological

Prognostic significance of pre-treatment ALBI grade in advanced non-small cell lung cancer receiving immune checkpoint therapy

“…They showed that the pre-treatment ALBI grade predicted prolonged OS, and that it was superior to the Child–Pugh grade in predicting mortality. In addition, kinoshita et al have compared pre-operative ALBI grade with clinicopathological characteristics and prognosis in patients with resectable non-small cell lung cancer, and reported that ALBI grade 2, 3 was associated with poor prognosis 20 . These previous reports support our results regarding its potential as a suitable biomarker for assessing prognosis in NSCLC.…”

The Association of Albumin-Bilirubin (ALBI) Grade with Mortality Risk in Trauma Patients with Liver Injuries

“…Patients who died had a significantly lower ALBI score than those who survived (2.8±0.4 vs 3.4±0.7, p < 0.001). Patients who died had a significantly lower GCS score (median [Q 1 -Q 3 ]; 8 [3][4][5][6][7][8][9][10][11][12][13] vs 15 [14][15], p < 0.001) but higher ISS (median [Q 1 -Q 3 ]; 33 [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] vs 20 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], p < 0.001) than the surviving patients.…”

“…[21][22][23][24][25][26][27] Patients with cholangiocarcinoma, 28 intrahepatic cholangiocarcinoma, 29 pancreatic cancer with liver metastases, 30 colorectal cancer with liver metastases, 31 and primary biliary cholangitis 32 can all benefit from knowing their ALBI grade as a prognostic indicator. Additionally, other non-hepatological disorders, including aortic dissection, 33 heart failure, 34,35 acute pancreatitis, 36 lung cancer, 24,37,38 esophageal cancer, 39 gastric cancer, 40 lung cancer, 41 and medulloblastoma, 42 have shown a high correlation between ALBI and death.…”

The ALBI score: From liver function in patients with HCC to a general measure of liver function

“…For example, ALBI has been shown to be prognostic in cancers other than HCC, including pancreatic, colon and gastric cancer, intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, and even brain cancer (glioma and medulloblastoma). [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] , [124] , [125] , [126] , [127] , [128] , [129] , [130] , [131] , [132] , [133] , [134] , [135] , [136] ALBI is likely to be reflective of liver dysfunction in patients undergoing hepatic resection for intrahepatic tumours, such as intrahepatic cholangiocarcinoma or metastatic liver tumours, and tolerance for those undergoing systemic therapy, including chemotherapies, molecular-targeted drugs and immune checkpoint inhibitors. 118 , 123 , [126] , [127] , [128] , 131 , 133 , 134 Although most authors have attempted to link the association of ALBI with a particular cancer to liver function, we should consider whether its association with mortality is actually through some aspect of liver dysfunction or whether it simply reflects the prognostic power of serum albumin and bilirubin levels, independent of liver function.…”

“… Kinoshita et al. 132 Retrospective 947 Non-small cell lung cancer ALBI grade 2/3 was an independent predictor of worse cancer-specific survival in patients who underwent resection. Matsukane et al.…”