title: Independent Analysis of Albumin-Bilirubin Grade in a 765-Patient Cohort Treated with Transarterial Locoregional Therapy for Hepatocellular Carcinoma.
abstract: OBJECTIVE
  To assess validity of albumin-bilirubin (ALBI) grade as a predictor of survival in patients undergoing transarterial embolization for hepatocellular carcinoma.
  
  
  METHODS
  Baseline albumin and bilirubin values of 765 consecutive patients treated with conventional transarterial chemoembolization or yttrium-90 ((90)Y) radioembolization at a single institution were used to determine liver function according to ALBI grade. Survival outcomes were stratified by ALBI grade using Kaplan-Meier and stratified by Child-Pugh (C-P) class and Barcelona Clinic Liver Cancer (BCLC) stage. Discriminatory ability was assessed by C-index.
  
  
  RESULTS
  For 428 patients receiving (90)Y radioembolization, ALBI grade yielded distinct survival curves (P < .001). When stratified by C-P class and BCLC stage, ALBI grade revealed different survival outcomes for C-P B (P = .001), BCLC A (P < .001), BCLC B (P = .001), and BCLC C (P < .001). When substratified by BCLC stage, ALBI grade was a better discriminator of survival than C-P class (C-index 0.792, 0.763, respectively). For 337 patients receiving transarterial chemoembolization, ALBI grade yielded distinct survival curves (P < .001). When stratified by C-P class and BCLC stage, ALBI grade provided distinct survival curves for C-P B (P = .02), BCLC B (P = .001), and BCLC C (P = .02). When substratified by BCLC stage, ALBI grade was a better discriminator of survival than C-P class (C-index 0.739, 0.735, respectively).
  
  
  CONCLUSIONS
  ALBI grade outperforms C-P class at discriminating survival in patients receiving transarterial chemoembolization or (90)Y radioembolization. ALBI grade is also valuable in patients with moderate liver dysfunction and BCLC B disease.
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ryan
authors.initials: R
authors.lastname: Hickey
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Samdeep
authors.initials: S
authors.lastname: Mouli
authors.affiliation: Department of Radiology, Divisions of Hepatology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Laura
authors.initials: L
authors.lastname: Kulik
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Kush
authors.initials: K
authors.lastname: Desai
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Bartley
authors.initials: B
authors.lastname: Thornburg
authors.affiliation: Department of Radiology, Divisions of Hepatology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.affiliation: Department of Medicine, and Division of Transplantation, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Talia
authors.initials: T
authors.lastname: Baker
authors.affiliation: Department of Medicine, and Division of Transplantation, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Michael
authors.initials: M
authors.lastname: Abecassis
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ralph Kallini
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Gabr
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Gates
authors.affiliation: Hematology and Oncology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson Iii
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Lewandowski
authors.affiliation: Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611; Department of Radiology, Divisions of Hepatology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611; Department of Medicine, and Division of Transplantation, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. Electronic address: r-salem@northwestern.edu.
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
mesh_terms: D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001663:Bilirubin / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002641:Chicago; D016208:Databases, Factual; D016002:Discriminant Analysis; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D000075462:Serum Albumin, Human; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D015021:Yttrium Radioisotopes / Q000008:administration & dosage
chemical_list: C422455:ALB protein, human; D000903:Antibiotics, Antineoplastic; D014408:Biomarkers, Tumor; D012709:Serum Albumin; D015021:Yttrium Radioisotopes; D004998:Ethiodized Oil; D004317:Doxorubicin; D001663:Bilirubin; D000075462:Serum Albumin, Human