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

Atsushi Hiraoka, Kojiro Michitaka, Takashi Kumada, Namiki Izumi, Masumi Kadoya, Norihiro Kokudo, Shoji Kubo, Yutaka Matsuyama, Osamu Nakashima, Michiie Sakamoto, Tadatoshi Takayama, Takashi Kokudo, Kosuke Kashiwabara, Masatoshi Kudo

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29 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)325-336
Number of pages12
JournalLiver Cancer
DOIs
Publication statusAccepted/In press - 2017 Sep 22

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Keywords

  • Albumin-bilirubin grade
  • Hepatocellular carcinoma
  • Japan Integrated Staging
  • Modified albumin-bilirubin grade
  • Prognosis
  • TNM stage

ASJC Scopus subject areas

  • Hepatology
  • Oncology

Cite this

Hiraoka, A., Michitaka, K., Kumada, T., Izumi, N., Kadoya, M., Kokudo, N., Kubo, S., Matsuyama, Y., Nakashima, O., Sakamoto, M., Takayama, T., Kokudo, T., Kashiwabara, K., & Kudo, M. (Accepted/In press). 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. Liver Cancer, 325-336. https://doi.org/10.1159/000479984