title: Integration of albumin-bilirubin (ALBI) score into Barcelona Clinic Liver Cancer (BCLC) system for hepatocellular carcinoma.
abstract: OBJECTIVE
  The albumin-bilirubin (ALBI) grade is a recently reported, simpler, more objective, and evidence-based alternative to the Child-Pugh (CP) score for hepatocellular carcinoma (HCC). We aimed to study whether ALBI grade could substitute for CP score in Barcelona Clinic Liver Cancer (BCLC) for HCC.
  
  
  METHODS
  An international multicentre cohort (n = 3696) was accrued to compare the prognostic performance of the CP-based and ALBI-based BCLC system, in terms of homogeneity, discriminatory ability, and monotonicity of gradients that were numerically reflected by homogeneity likelihood, linear trend chi-squares, and c-indices, respectively.
  
  
  RESULTS
  The ALBI grade performed as well as CP score when integrated into the BCLC staging system in terms of predicting clinical outcome of HCC regardless of regions, etiology, and treatment options. CP-based and ALBI-based BCLC systems were highly concordant with weighted kappa value of 0.917. All restaged patients showed significantly different clinical outcomes compared with their original stage classification. In particular, ALBI-based BCLC upstaged 83 (2.2%) patients from lower CP-based BC LC stages to ALBI-based BCLC stage D, whose median overall survival was only 3 months.
  
  
  CONCLUSIONS
  The overall prognostic performance of ALBI-based and CP-based BCLC systems was similar. It also potentially allows more precise patient selection for clinical trials on systemic agents.
authors.affiliation: Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.
authors.forename: Anthony W H
authors.initials: AW
authors.lastname: Chan
authors.affiliation: Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Takshi
authors.initials: T
authors.lastname: Kumada
authors.affiliation: Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong kong.
authors.forename: Charing C N
authors.initials: CC
authors.lastname: Chong
authors.affiliation: Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.
authors.forename: Frankie K F
authors.initials: FK
authors.lastname: Mo
authors.affiliation: Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, University of Liverpool Liverpool, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Johnson
authors.affiliation: Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan.|Department of Molecular and Clinical Cancer Medicine, University of Liverpool Liverpool, UK.
authors.forename: Paul B S
authors.initials: PB
authors.lastname: Lai
authors.affiliation: Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.
authors.forename: Anthony T C
authors.initials: AT
authors.lastname: Chan
authors.affiliation: Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.|Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong kong.|Li Ka Shing Institute of Health Sciences, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Ka-Fai
authors.initials: KF
authors.lastname: To
authors.affiliation: Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong.|Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong kong.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009367:Neoplasm Staging / Q000379:methods*; D018579:Patient Selection; D011379:Prognosis; D012709:Serum Albumin
chemical_list: D014408:Biomarkers, Tumor; D012709:Serum Albumin; D001663:Bilirubin
keywords: Barcelona Clinic Liver Cancer (BCLC); Child-Pugh score; albumin; bilirubin; liver function; prognosis; survival; tumor staging