title: ALBI and PALBI grade predict survival for HCC across treatment modalities and BCLC stages in the MELD Era.
abstract: OBJECTIVE
  The severity of liver dysfunction in hepatocellular carcinoma (HCC) is often estimated with Child-Turcotte-Pugh (CTP) classification or model for end-stage liver disease (MELD) score. We aim to investigate the performance of albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade, which are recently reported to be simple and objective measurements for liver reserve in HCC.
  
  
  METHODS
  Between 2002 and 2014, consecutive 3182 HCC patients were enrolled to follow up their survival. The area under receiver-operator-characteristic curve (AUC) was calculated to test the discriminatory powers over 1-year, 3-year, and 5-year survival.
  
  
  RESULTS
  Significant survival differences were found across all ALBI and PALBI grades (both P < 0.001). The majority (73%) of patients were CTP class A. Within CTP class A, ALBI revealed two prognostic groups while PALBI segregated three prognostic groups. The PABLI grade also identified three different survival groups for patients undergoing resection, ablation, and chemoembolization. Both ALBI and PALBI grade were capable of discerning survival among different HCC stages. The PALBI grade had significantly higher AUC compared with CTP classification and ALBI grade at 1, 3, and 5 years. For CTP class A patients, the PALBI grade was also associated with significantly higher AUC compared with ALBI grade at 1-year and 3-year intervals. The MELD score has the lowest AUC compared with other systems.
  
  
  CONCLUSIONS
  Both ALBI and PALBI grade are adequate models to assess liver dysfunction in HCC. The PALBI grade is consistently better in all patients, in patients with minimally decreased liver function, and in patients receiving different aggressive therapies.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Po-Hong
authors.initials: PH
authors.lastname: Liu
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.|Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Fa-Yauh
authors.initials: FY
authors.lastname: Lee
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Hou
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.|Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D000359:Aftercare; D000368:Aged; D000418:Albumins; D001663:Bilirubin; D015415:Biomarkers; D001792:Blood Platelets; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests / Q000379:methods*; D008113:Liver Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000418:Albumins; D015415:Biomarkers; D001663:Bilirubin
keywords: ALBI grade; MELD score; PALBI grade; cirrhosis; hepatocellular carcinoma