Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade - PubMed (original) (raw)

. 2015 Feb 20;33(6):550-8.

doi: 10.1200/JCO.2014.57.9151. Epub 2014 Dec 15.

Sarah Berhane 2, Chiaki Kagebayashi 2, Shinji Satomura 2, Mabel Teng 2, Helen L Reeves 2, James O'Beirne 2, Richard Fox 2, Anna Skowronska 2, Daniel Palmer 2, Winnie Yeo 2, Frankie Mo 2, Paul Lai 2, Mercedes Iñarrairaegui 2, Stephen L Chan 2, Bruno Sangro 2, Rebecca Miksad 2, Toshifumi Tada 2, Takashi Kumada 2, Hidenori Toyoda 2

Affiliations

Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade

Philip J Johnson et al. J Clin Oncol. 2015.

Abstract

Purpose: Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade.

Patients and methods: We developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501).

Results: The model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function.

Conclusion: The ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.

© 2014 by American Society of Clinical Oncology.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.

Fig 1.

Application of the Albumin-Bilirubin (ALBI) model and comparison with Child-Pugh (C-P) grade. Kaplan-Meier curves depict survival according to (A, C, E, and G) ALBI and (B, D, F, and H) C-P class in (A and B) Japanese, (C and D) European, (E and F) Chinese, and (G and H) US cohorts. Associated tables display the median survival (in months) for each curve as well as Harrell's C and Somers' D scores.

Fig 1.

Fig 1.

Application of the Albumin-Bilirubin (ALBI) model and comparison with Child-Pugh (C-P) grade. Kaplan-Meier curves depict survival according to (A, C, E, and G) ALBI and (B, D, F, and H) C-P class in (A and B) Japanese, (C and D) European, (E and F) Chinese, and (G and H) US cohorts. Associated tables display the median survival (in months) for each curve as well as Harrell's C and Somers' D scores.

Fig 2.

Fig 2.

Performance of the Albumin-Bilirubin (ALBI) model in patients with hepatocellular carcinoma with Child-Pugh (C-P) grade A. Kaplan-Meier curves depict survival according to ALBI grades within C-P grade A patients of the (A) Japanese, (B) European/US, and (C) Chinese cohorts. Associated tables display the median survival (in months) for each curve.

Fig 3.

Fig 3.

Performance of the Albumin-Bilirubin (ALBI) model in patients undergoing sorafenib treatment, those undergoing resection, and those with cirrhosis (without hepatocellular carcinoma). Kaplan-Meier curves illustrate survival according to ALBI grades in patients (A) treated with sorafenib as part of a clinical trial, (B) with cirrhosis alone, and (C) undergoing resection. (D) Corresponding Child-Pugh grades for the resected patients shown in (C). Associated tables display the median survival (in months) for each curve.

Fig 4.

Fig 4.

Nomogram for rapid assessment of the Albumin-Bilirubin (ALBI) score. Colors refer to ALBI grades A1, A2, and A3.

Fig A1.

Fig A1.

Kaplan-Meier curves showing survival in the Japanese, European, Chinese, and US cohorts.

Fig A2.

Fig A2.

Application of the Albumin-Bilirubin (ALBI) model to the training and validation sets. Kaplan-Meier curves depicting survival according to ALBI and Child-Pugh (C-P) grade in the (A and B) Japanese training set and (C and D) validation set.

Fig A3.

Fig A3.

Heat map for rapid assessment of the Albumin-Bilirubin (ALBI) grade.

Comment in

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