Usefulness of albumin–bilirubin grade for evaluation of prognosis of 2584 Japanese patients with hepatocellular carcinoma

Hiraoka, Atsushi; Kumada, Takashi; Michitaka, Kojiro; Toyoda, Hidenori; Tada, Toshifumi; Ueki, Hidetaro; Kaneto, Miho; Aibiki, Toshihiko; Okudaira, Taeko; Kawakami, Takamasa; Kawamura, Tomoe; Yamago, Hiroka; Suga, Yasuhiro; Miyamoto, Yuji; Tomida, Hideomi; Azemoto, Nobuaki; Mori, Kenichirou; Miyata, Hideki; Nakamura, Tomoyuki; Kawasaki, Hideki

doi:10.1111/jgh.13250

Cited by 213 publications

(244 citation statements)

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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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“…Moreover, there might also be problems when liver damage and Child-Pugh, which has been reported to be inferior to liver damage [8] , are used together in the evidence-based JSH guideline. The newly proposed ALBI grade [9] was shown to provide a better estimation of hepatic function than the ChildPugh classification [13] , and can be calculated with only albumin and total bilirubin data. Indeed, no need for imaging assessment of ascites, encephalopathy, subjective evaluation, or ICG-R15 is thought to be an advantage of ALBI grade as compared with the other classifications.…”

Section: Discussionmentioning

confidence: 99%

“…The distribution of ICG-R15 in each classification of hepatic function was investigated. JIS score was calculated using TNM stage of LCSGJ and Child-Pugh class [17,18] , modified JIS score using TNM stage of LCSGJ and liver damage [19] , and ALBI-T using TNM stage of LCSGJ and ALBI grade [13] .…”

Section: Comparison Between Three Methods For Evaluation Of Hepatic Fmentioning

confidence: 99%

“…ALBI grade [13] and liver damage [8] have been reported to have better capability for evaluation of hepatic function in Japanese HCC patients as compared to the Child-Pugh classification, though few studies have assessed the correlation between them. In the present study, we investigated the clinical usefulness of the ALBI grade by comparing it with both the liver damage and Child-Pugh classifications to analyze whether the ALBI grade can be substituted for the liver damage classification in the evidence-based JSH guideline.…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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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Management of Hepatocellular Carcinoma

et al. 2023

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ImportanceHepatocellular carcinoma (HCC) is the sixth most common malignancy and fourth leading cause of cancer-related death worldwide. Recent advances in systemic and locoregional therapies have led to changes in many guidelines regarding systemic therapy, as well as the possibility to downstage patients to undergo resection. This review examines the advances in surgical and medical therapies relative to multidisciplinary treatment strategies for HCC.ObservationsHCC is a major health problem worldwide. The obesity epidemic has made nonalcoholic fatty liver disease a major risk factor for the development of HCC. Multiple societies, such as the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver, the Asian Pacific Association for the Study of the Liver, and the National Comprehensive Cancer Network, provide guidelines for screening at-risk patients, as well as define staging systems to guide optimal treatment strategies. The Barcelona Clinic Liver Cancer staging system is widely accepted and has recently undergone updates with the introduction of new systemic therapies and stage migration.Conclusions and RelevanceThe treatment of patients with HCC should involve a multidisciplinary approach with collaboration among surgeons, medical oncologists, radiation oncologists, and interventional radiologists to provide optimal care. Treatment paradigms must consider both tumor and patient-related factors such as extent of liver disease, which is a main driver of morbidity and mortality. The advent of more effective systemic and locoregional therapies has prolonged survival among patients with advanced disease and allowed some patients to undergo surgical intervention who would otherwise have disease considered unresectable.

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Usefulness of albumin–bilirubin grade for evaluation of prognosis of 2584 Japanese patients with hepatocellular carcinoma

Cited by 213 publications

References 29 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

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

Management of Hepatocellular Carcinoma

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