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. 2021 Feb 1;84(2):136-143.
doi: 10.1097/JCMA.0000000000000482.

The role of albumin-bilirubin grade in determining the outcomes of patients with very early-stage hepatocellular carcinoma

Chung-Yu Chang  1   2 , Cheng-Yi Wei  1 , Ping-Hsien Chen  3   4   5 , Ming-Chih Hou  1   4 , Yee Chao  4   6 , Gar-Yang Chau  4   7 , Rheun-Chuan Lee  4   8 , Yi-Hsiang Huang  1   4   9 , Yu-Hui Su  10 , Jaw-Ching Wu  9   11   12 , Chien-Wei Su  1   4   13
Affiliations

The role of albumin-bilirubin grade in determining the outcomes of patients with very early-stage hepatocellular carcinoma

Chung-Yu Chang et al. J Chin Med Assoc. .

Abstract

Background: Patients with hepatocellular carcinoma (HCC) and with a single tumor <2 cm in size are classified as having Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC. We aimed to investigate the role of the albumin-bilirubin (ALBI) grade in predicting outcomes in patients with BCLC stage 0 HCC.

Methods: We retrospectively enrolled patients with BCLC stage 0 HCC in Taipei Veterans General Hospital from 2007 to 2015. Prognostic factors were analyzed using a Cox proportional hazards model and propensity score matching (PSM) analysis.

Results: There were 420 patients enrolled, including 207 with ALBI grade 1, and 213 with ALBI grade 2 or 3. After a median follow-up of 60.0 months (interquartile range, 37.2-84.6 months), 179 patients died. The cumulative 5-year overall survival (OS) rates were 80.6% in patients with ALBI grade 1 and 53.7% in those with ALBI grade 2 or 3, respectively (p < 0.001). Multivariate analysis showed that age >65 years, negative hepatitis B surface in serum, creatinine >1.0 mg/dL, platelet count ≤105/mm3, tumor size >1.5 cm, nonsurgical resection (SR) therapy, and higher ALBI grade were independent risk factors related to poor OS. Patients who underwent SR had a better OS and recurrence-free survival than those who received radiofrequency ablation, which was confirmed by a multivariate analysis and PSM analysis.

Conclusion: The ALBI grade can determine OS for patients with BCLC stage 0 HCC. SR can also provide a better outcome than nonsurgical treatment.

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Conflict of interest statement

Conflicts of Interest Statement: Dr Su: Speakers’ bureau: Gilead Sciences, Bristol-Myers Squibb, AbbVie, Bayer, and Roche; Advisory arrangements: Gilead Sciences; Grants: Bristol-Myers Squibb, and Eiger. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

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