title: Proposed New Sub-Grouping for Intermediate-Stage Hepatocellular Carcinoma Using Albumin-Bilirubin Grade.
abstract: OBJECTIVE
  We retrospectively evaluated the efficacy of albumin-bilirubin (ALBI) grade, which has been proposed as a new classification for hepatic function, for evaluation of the prognosis of intermediate-stage hepatocellular carcinoma (Barcelona Clinic Liver Cancer criteria stage B, BCLC-B).
  
  
  METHODS
  We enrolled 754 naïve BCLC-B patients (multiple tumors) and retrospectively analyzed their clinical features [surgical resection (hepatectomy), n = 170; radiofrequency ablation (RFA), n = 110; percutaneous ethanol injection, n = 7; transcatheter arterial chemoembolization, n = 396; others, n = 25; best supportive care, n = 46]. Four sub-groups were defined for the Modified Intermediate Stage of Liver Cancer (MICAN) criteria as follows: B1 (ALBI-1/within up-to-7 criteria), B2 (ALBI-2/within up-to-7 criteria), B3 (ALBI-1 and ALBI-2/multiple and beyond up-to-7 criteria), and B4 (ALBI-3/any).
  
  
  RESULTS
  The median survival time of patients classified as B1 (n = 94), B2 (n = 175), B3 (n = 452), and B4 (n = 33) was 65.1, 48.1, 29.6, and 14.6 months, respectively (p < 0.01 for each). Those in B1 treated with hepatectomy and RFA comprised 67.0%, while that ratio was 51.4% in B2, 28.3% in B3, and 12.1% in B4.
  
  
  CONCLUSIONS
  The MICAN criteria based on ALBI grade are simple and useful for prediction of prognosis and therapy decision-making in the heterogeneous population of BCLC-B patients.
authors.affiliation: Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nouso
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuji
authors.forename: Ei
authors.initials: E
authors.lastname: Itobayashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kariyama
authors.forename: Toru
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawasaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
authors.forename: Kojiro
authors.initials: K
authors.lastname: Michitaka
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology* / Q000628:therapy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D000066491:Clinical Decision-Making / Q000379:methods; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate
chemical_list: D012709:Serum Albumin; D001663:Bilirubin