title: Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade.
abstract: BACKGROUND
  Application of curative therapy for hepatocellular carcinoma is crucially dependent on underlying liver function. Using the recently described ALBI grade we examined the long-term impact of liver dysfunction on survival of early-stage hepatocellular carcinoma (HCC) patients.
  
  
  METHODS
  This cohort study comprised 2559 HCC patients from different geographic regions, all treated with curative intent. We also examined the relation between indocyanine green (ICG) clearance and ALBI score. Survival was measured from the date of treatment to the date of death or last follow-up.
  
  
  RESULTS
  The ALBI score correlated well with ICG clearance. Among those undergoing surgical resection, patients with ALBI grade-1 (good liver function) survived approximately twice as long as those with ALBI grade-2 (less good liver function), although more than 90% of these patients were classified as Child-Pugh (C-P) grade A. In the cohort receiving ablative therapies, there was a similar difference in survival between ALBI grade-1 and grade-2. Cox regression analysis confirmed that the ALBI score along with age, gender, aetiology and tumour factors (AFP, tumour size/number and vascular invasion) independently influenced survival in HCC patients receiving curative treatments.
  
  
  CONCLUSIONS
  The ALBI score represents a simple approach to the assessment of liver function in patients with HCC. After potentially curative therapy, those with ALBI grade-1 survived approximately twice as long as those with ALBI grade-2. These data suggest that ALBI grade-1 patients are appropriately treated with surgical resection whereas ALBI grade-2 patients may, where the option exists, be more suitable for liver transplantation or the less invasive curative ablative therapies.
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Paul B S
authors.initials: PB
authors.lastname: Lai
authors.affiliation: The Sheila Sherlock Liver Centre, Royal Free Hospital, London NW3 2QG, UK.
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Charing C
authors.initials: CC
authors.lastname: Chong
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, The Duncan Building, Daulby Street, University of Liverpool, Liverpool L69 3GA, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Berhane
authors.affiliation: Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.|The Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Freeman Road, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Reeves
authors.affiliation: The Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Freeman Road, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK.
authors.forename: Derek
authors.initials: D
authors.lastname: Manas
authors.affiliation: Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Fox
authors.affiliation: State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.affiliation: State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Frankie
authors.initials: F
authors.lastname: Mo
authors.affiliation: Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Anthony W H
authors.initials: AW
authors.lastname: Chan
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.affiliation: Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Straβe 1, 30625 Hannover, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Vogel
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Straβe 1, 30625 Hannover, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Schweitzer
authors.affiliation: State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, The Duncan Building, Daulby Street, University of Liverpool, Liverpool L69 3GA, UK.|The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D015996:Survival Rate