The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma

David J. Pinato, Rohini Sharma, Elias Allara, Clarence Yen, Tadaaki Arizumi, Keiichi Kubota, Dominik Bettinger, Jeong Won Jang, Carlo Smirne, Young Woon Kim, Masatoshi Kudo, Jessica Howell, Ramya Ramaswami, Michela E. Burlone, Vito Guerra, Robert Thimme, Mitsuru Ishizuka, Justin Stebbing, Mario Pirisi, Brian I. Carr

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background & Aims: Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC) due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in hepatocellular carcinoma, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate stage HCC, where OS is highly heterogeneous. Methods: We evaluated the prognostic accuracy of the ALBI grade in estimating OS in a large, multi-centre study of 2426 patients, including a large proportion of intermediate stage patients treated with chemoembolization (n = 1461) accrued from Europe, the United States and Asia. Results: Analysis of survival by primary treatment modality confirmed the ALBI grade as a significant predictor of patient OS after surgical resection (p . <0.001), transarterial chemoembolization (p . <0.001) and sorafenib (p . <0.001). Stratification by Barcelona Clinic Liver Cancer stage confirmed the independent prognostic value of the ALBI across the diverse stages of the disease, geographical regions of origin and time of recruitment to the study (p . <0.001). Conclusions: In this large, multi-centre retrospective study, the ALBI grade satisfied the criteria for accuracy and reproducibility following statistical validation in Eastern and Western HCC patients, including those treated with chemoembolization. Consideration should be given to the ALBI grade as a stratifying biomarker of liver reserve in routine clinical practice. Lay summary: Liver failure is a key determinant influencing the natural history of hepatocellular carcinoma (HCC). In this large multi-centre study we externally validate a novel biomarker of liver functional reserve, the ALBI grade, across all the stages of HCC.

Original languageEnglish
JournalJournal of Hepatology
DOIs
Publication statusAccepted/In press - Dec 22 2015

Fingerprint

Hepatocellular Carcinoma
Liver
Survival
Biomarkers
Liver Failure
Liver Neoplasms
Survival Analysis
Bilirubin
Liver Diseases
Albumins
Fibrosis
Retrospective Studies
Mortality
Neoplasms
Therapeutics

Keywords

  • ALBI
  • Albumins
  • Bilirubin
  • Biomarkers
  • Carcinoma
  • Hepatocellular
  • Liver failure
  • Prognosis
  • Retrospective studies

ASJC Scopus subject areas

  • Hepatology

Cite this

The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. / Pinato, David J.; Sharma, Rohini; Allara, Elias; Yen, Clarence; Arizumi, Tadaaki; Kubota, Keiichi; Bettinger, Dominik; Jang, Jeong Won; Smirne, Carlo; Kim, Young Woon; Kudo, Masatoshi; Howell, Jessica; Ramaswami, Ramya; Burlone, Michela E.; Guerra, Vito; Thimme, Robert; Ishizuka, Mitsuru; Stebbing, Justin; Pirisi, Mario; Carr, Brian I.

In: Journal of Hepatology, 22.12.2015.

Research output: Contribution to journalArticle

Pinato, DJ, Sharma, R, Allara, E, Yen, C, Arizumi, T, Kubota, K, Bettinger, D, Jang, JW, Smirne, C, Kim, YW, Kudo, M, Howell, J, Ramaswami, R, Burlone, ME, Guerra, V, Thimme, R, Ishizuka, M, Stebbing, J, Pirisi, M & Carr, BI 2015, 'The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma', Journal of Hepatology. https://doi.org/10.1016/j.jhep.2016.09.008
Pinato, David J. ; Sharma, Rohini ; Allara, Elias ; Yen, Clarence ; Arizumi, Tadaaki ; Kubota, Keiichi ; Bettinger, Dominik ; Jang, Jeong Won ; Smirne, Carlo ; Kim, Young Woon ; Kudo, Masatoshi ; Howell, Jessica ; Ramaswami, Ramya ; Burlone, Michela E. ; Guerra, Vito ; Thimme, Robert ; Ishizuka, Mitsuru ; Stebbing, Justin ; Pirisi, Mario ; Carr, Brian I. / The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. In: Journal of Hepatology. 2015.
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abstract = "Background & Aims: Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC) due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in hepatocellular carcinoma, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate stage HCC, where OS is highly heterogeneous. Methods: We evaluated the prognostic accuracy of the ALBI grade in estimating OS in a large, multi-centre study of 2426 patients, including a large proportion of intermediate stage patients treated with chemoembolization (n = 1461) accrued from Europe, the United States and Asia. Results: Analysis of survival by primary treatment modality confirmed the ALBI grade as a significant predictor of patient OS after surgical resection (p . <0.001), transarterial chemoembolization (p . <0.001) and sorafenib (p . <0.001). Stratification by Barcelona Clinic Liver Cancer stage confirmed the independent prognostic value of the ALBI across the diverse stages of the disease, geographical regions of origin and time of recruitment to the study (p . <0.001). Conclusions: In this large, multi-centre retrospective study, the ALBI grade satisfied the criteria for accuracy and reproducibility following statistical validation in Eastern and Western HCC patients, including those treated with chemoembolization. Consideration should be given to the ALBI grade as a stratifying biomarker of liver reserve in routine clinical practice. Lay summary: Liver failure is a key determinant influencing the natural history of hepatocellular carcinoma (HCC). In this large multi-centre study we externally validate a novel biomarker of liver functional reserve, the ALBI grade, across all the stages of HCC.",
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AU - Pinato, David J.

AU - Sharma, Rohini

AU - Allara, Elias

AU - Yen, Clarence

AU - Arizumi, Tadaaki

AU - Kubota, Keiichi

AU - Bettinger, Dominik

AU - Jang, Jeong Won

AU - Smirne, Carlo

AU - Kim, Young Woon

AU - Kudo, Masatoshi

AU - Howell, Jessica

AU - Ramaswami, Ramya

AU - Burlone, Michela E.

AU - Guerra, Vito

AU - Thimme, Robert

AU - Ishizuka, Mitsuru

AU - Stebbing, Justin

AU - Pirisi, Mario

AU - Carr, Brian I.

PY - 2015/12/22

Y1 - 2015/12/22

N2 - Background & Aims: Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC) due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in hepatocellular carcinoma, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate stage HCC, where OS is highly heterogeneous. Methods: We evaluated the prognostic accuracy of the ALBI grade in estimating OS in a large, multi-centre study of 2426 patients, including a large proportion of intermediate stage patients treated with chemoembolization (n = 1461) accrued from Europe, the United States and Asia. Results: Analysis of survival by primary treatment modality confirmed the ALBI grade as a significant predictor of patient OS after surgical resection (p . <0.001), transarterial chemoembolization (p . <0.001) and sorafenib (p . <0.001). Stratification by Barcelona Clinic Liver Cancer stage confirmed the independent prognostic value of the ALBI across the diverse stages of the disease, geographical regions of origin and time of recruitment to the study (p . <0.001). Conclusions: In this large, multi-centre retrospective study, the ALBI grade satisfied the criteria for accuracy and reproducibility following statistical validation in Eastern and Western HCC patients, including those treated with chemoembolization. Consideration should be given to the ALBI grade as a stratifying biomarker of liver reserve in routine clinical practice. Lay summary: Liver failure is a key determinant influencing the natural history of hepatocellular carcinoma (HCC). In this large multi-centre study we externally validate a novel biomarker of liver functional reserve, the ALBI grade, across all the stages of HCC.

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KW - Albumins

KW - Bilirubin

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KW - Carcinoma

KW - Hepatocellular

KW - Liver failure

KW - Prognosis

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