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. 2016 Mar 29;114(7):744-50.
doi: 10.1038/bjc.2016.33.

Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade

Hidenori Toyoda  1 , Paul B S Lai  2 , James O'Beirne  3 , Charing C Chong  2 , Sarah Berhane  4 , Helen Reeves  5   6 , Derek Manas  6 , Richard P Fox  7 , Winnie Yeo  8 , Frankie Mo  8 , Anthony W H Chan  9 , Toshifumi Tada  1 , Mercedes Iñarrairaegui  10 , Arndt Vogel  11 , Nora Schweitzer  11 , Stephen L Chan  8 , Bruno Sangro  10 , Takashi Kumada  1 , Philip J Johnson  4   12
Affiliations

Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade

Hidenori Toyoda et al. Br J Cancer. .

Abstract

Background: Application of curative therapy for hepatocellular carcinoma is crucially dependent on underlying liver function. Using the recently described ALBI grade we examined the long-term impact of liver dysfunction on survival of early-stage hepatocellular carcinoma (HCC) patients.

Methods: This cohort study comprised 2559 HCC patients from different geographic regions, all treated with curative intent. We also examined the relation between indocyanine green (ICG) clearance and ALBI score. Survival was measured from the date of treatment to the date of death or last follow-up.

Results: The ALBI score correlated well with ICG clearance. Among those undergoing surgical resection, patients with ALBI grade-1 (good liver function) survived approximately twice as long as those with ALBI grade-2 (less good liver function), although more than 90% of these patients were classified as Child-Pugh (C-P) grade A. In the cohort receiving ablative therapies, there was a similar difference in survival between ALBI grade-1 and grade-2. Cox regression analysis confirmed that the ALBI score along with age, gender, aetiology and tumour factors (AFP, tumour size/number and vascular invasion) independently influenced survival in HCC patients receiving curative treatments.

Conclusions: The ALBI score represents a simple approach to the assessment of liver function in patients with HCC. After potentially curative therapy, those with ALBI grade-1 survived approximately twice as long as those with ALBI grade-2. These data suggest that ALBI grade-1 patients are appropriately treated with surgical resection whereas ALBI grade-2 patients may, where the option exists, be more suitable for liver transplantation or the less invasive curative ablative therapies.

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Figures

Figure 1
Figure 1
Survival according to ALBI grade in all patients undergoing resection and ablative treatment.
Figure 2
Figure 2
Survival according to ALBI grade in C-P grade A patients undergoing resection in (A) Japan, (B) Hong Kong and (C) Europe.
Figure 3
Figure 3
Survival according to ALBI grade in patients undergoing RFA and other ablative therapies in (A) Japanese, (B) Hong Kong and (C) European cohorts.
Figure 4
Figure 4
Raw data scatterplots showing with 95% CI correlation between ALBI score and (A) sqrt(ICG) clearance (r=0.67, n=2190, P<0.0001) and (B) WHPG (r=0.55, n=52, P<0.0001). WHPG = wedged hepatic portal hepatic gradient.
See this image and copyright information in PMC

Comment in

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