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Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach - The ALBI Grade

Lookup NU author(s): Professor Helen Reeves

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Abstract

PurposeMost patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade.Patients and MethodsWe developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501).ResultsThe model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function.ConclusionThe ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade. (C) 2014 by American Society of Clinical Oncology


Publication metadata

Author(s): Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O'Beirne J, Fox R, Skowronska A, Palmer D, Yeo W, Mo F, Lai P, Inarrairaegui M, Chan SL, Sangro B, Miksad R, Tada T, Kumada T, Toyoda H

Publication type: Article

Publication status: Published

Journal: Journal of Clinical Oncology

Year: 2015

Volume: 33

Issue: 6

Pages: 550-558

Print publication date: 20/02/2015

Online publication date: 15/12/2014

Acceptance date: 01/01/1900

ISSN (print): 0732-183X

ISSN (electronic): 1527-7755

Publisher: American Society of Clinical Oncology

URL: .http;//dx.doi.org/10.1200/JCO.2014.57.9151

DOI: 10.1200/JCO.2014.57.9151


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Funding

Funder referenceFunder name
Instituto de Salud Carlos III (Spain)
K23CA139005National Cancer Institute

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