The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma.
Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC) due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in hepatocellular carcinoma, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate stage HCC, where OS is highly heterogeneous.



We evaluated the prognostic accuracy of the ALBI grade in estimating OS in a large, multi-centre study of 2426 patients, including a large proportion of intermediate stage patients treated with chemoembolization (n=1461) accrued from Europe, the United States and Asia.



Analysis of survival by primary treatment modality confirmed the ALBI grade as a significant predictor of patient OS after surgical resection (p<0.001), transarterial chemoembolization (p<0.001) and sorafenib (p<0.001). Stratification by Barcelona Clinic Liver Cancer stage confirmed the independent prognostic value of the ALBI across the diverse stages of the disease, geographical regions of origin and time of recruitment to the study (p<0.001).



In this large, multi-centre retrospective study, the ALBI grade satisfied the criteria for accuracy and reproducibility following statistical validation in Eastern and Western HCC patients, including those treated with chemoembolization. Consideration should be given to the ALBI grade as a stratifying biomarker of liver reserve in routine clinical practice.



Liver failure is a key determinant influencing the natural history of hepatocellular carcinoma (HCC). In this large multi-centre study we externally validate a novel biomarker of liver functional reserve, the ALBI grade, across all the stages of HCC.
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK. Electronic address: david.pinato@imperial.ac.uk.
David J
DJ
Pinato
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK.
Rohini
R
Sharma
NIHR Blood and Transplant Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
Elias
E
Allara
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK.
Clarence
C
Yen
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
Tadaaki
T
Arizumi
Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan.
Keiichi
K
Kubota
Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.
Dominik
D
Bettinger
Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Seoul, Republic of Korea.
Jeong Won
JW
Jang
Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, Novara, Italy.
Carlo
C
Smirne
Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Seoul, Republic of Korea.
Young Woon
YW
Kim
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
Masatoshi
M
Kudo
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK.
Jessica
J
Howell
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK.
Ramya
R
Ramaswami
Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, Novara, Italy.
Michela E
ME
Burlone
IRCCS De Bellis, National Institute for Digestive Diseases, Castellana Grotte, Italy.
Vito
V
Guerra
Department of Medicine II, University Hospital Freiburg, Freiburg, Germany.
Robert
R
Thimme
Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan.
Mitsuru
M
Ishizuka
Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK.
Justin
J
Stebbing
Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, Novara, Italy.
Mario
M
Pirisi
Izmir Biomedicine and Genome Centre, Dokuz Eylul University, Izmir, Turkey.
Brian I
BI
Carr
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000032:analysis*; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063305:Organ Dysfunction Scores; D011379:Prognosis; D015203:Reproducibility of Results; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis
D014408:Biomarkers, Tumor; D012709:Serum Albumin; D001663:Bilirubin
ALBI; Albumins; Bilirubin; Biomarkers; Carcinoma; Hepatocellular; Liver failure; Prognosis; Retrospective studies