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

Abstract

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.

ALBI Score as a Novel Tool in Staging and Treatment Planning for Hepatocellular Carcinoma: Advantage of ALBI Grade for Universal Assessment of Hepatic Function

“…Moreover, there is an additional advantage with ALBI grade. A modified version has been proposed with 4 grades (1, 2a, 2b, and 3) (modified ALBI [mALBI] grade) for more detailed assessment based on the cut-off value (ALBI score = -2.270) for ICG-R15 (<30%) [4]. In the results of additional analyses, AIC and c-index of mALBI/mALBI-T were better than the others (Fig.…”

Combination of Resection and Ablative Treatment for Hepatocellular Carcinoma: Usefulness of Complementary Radiofrequency Ablation

“…Also, the Fib-4 index [12] value was higher in the Comb group than the SR group (6.30 ± 5.34 vs. 3.92 ± 2.61, p = 0.012), while findings regarding TNM stage of the LCSGJ were not significantly different between them ( p = 0.640). Therefore, there were no significant differences between the groups in regard to JIS [13] scores ( p = 0.176), whereas the scores for ALBI-T [14] and mALBI-T [10] indicated significant differences between the groups ( p = 0.027 and 0.004, respectively; data not shown).…”

“…Recently, ALBI grade has been reported to have a better assessment ability for obtaining good hepatic reserve function in treated patients [10, 14, 27, 28]. Among the present 115 naïve HCC patients who had multiple countable tumors (≤5) and unmet needs, hepatic function in the Comb group was worse as compared to that in the SR group when assessed by ALBI grade (ALBI grade 1: 42.4 vs. 64.6%, p = 0.034) as well as Fib-4 index (6.30 ± 5.34 vs. 3.75 ± 2.10, p = 0.019), whereas OS and DFS rates were not significantly different between the groups.…”

“…The ALBI score was calculated based on serum albumin and total-bilirubin using the following formula: (log 10 bilirubin [µmol/L] × 0.66 + albumin [g/L]) × –0.085), with the ALBI grade defined by the resultant score (≤–2.60 = grade 1, >–2.60 to ≤–1.39 = grade 2, >–1.39 = grade 3) [9]. The wide middle grade of ALBI 2 was divided into 2 subgrades (2a and 2b) with a cut-off ALBI score of –2.270, resulting in 4 modified ALBI (mALBI) grades [10, 11]. …”

“…The Japan Integrated Scoring system (JIS) [13] was calculated by summing the scores for Child-Pugh class and TNM stage. ALBI-TNM (ALBI-T) [14] and mALBI-TNM (mALBI-T) [10, 11] were calculated using either ALBI grade/mALBI grade and TNM stage, respectively, and then calculated in the same manner as JIS.…”