title: A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma.
abstract: The Albumin-Bilirubin (ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification.
  
  
  
  We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival (OS) was analysed using the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion.
  
  
  
  Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P < 0.001), Hazard Ratio (HR) = 1.60 (95%CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population.
  
  
  
  Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy.
authors.affiliation: Centre Eugène Marquis, Rennes, France.
authors.forename: Julien
authors.identifier: 0000-0002-8289-7741
authors.initials: J
authors.lastname: Edeline
authors.affiliation: Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Blanc
authors.affiliation: University of Liverpool, Liverpool, UK.|Clatterbridge Cancer Centre, Liverpool, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Centre Eugène Marquis, Rennes, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Campillo-Gimenez
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Ross
authors.affiliation: University of Birmingham, Birmingham, UK.|University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Yuk Ting
authors.initials: YT
authors.lastname: Ma
authors.affiliation: Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Judy
authors.initials: J
authors.lastname: King
authors.affiliation: The Christie NHS Foundation Trust, Manchester, UK.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hubner
authors.affiliation: The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Sumpter
authors.affiliation: Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Darby
authors.affiliation: University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK.
authors.forename: Jeff
authors.initials: J
authors.lastname: Evans
authors.affiliation: Leicester Royal Infirmary, Leicester, UK.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Iwuji
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Swinson
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Collins
authors.affiliation: Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
authors.forename: Kinnari
authors.initials: K
authors.lastname: Patel
authors.affiliation: Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
authors.forename: Iqtedar
authors.initials: I
authors.lastname: Muazzam
authors.affiliation: University of Liverpool, Liverpool, UK.|Clatterbridge Cancer Centre, Liverpool, UK.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Palmer
authors.affiliation: Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.|UCL Cancer Institute, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001663:Bilirubin / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D000077157:Sorafenib; D016019:Survival Analysis; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D012709:Serum Albumin; D009536:Niacinamide; D000077157:Sorafenib; D001663:Bilirubin
keywords: albumin; bilirubin; cirrhosis; liver function; prognosis