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. 2021 Apr;14(4):101038.
doi: 10.1016/j.tranon.2021.101038. Epub 2021 Feb 14.

High preoperative albumin-bilirubin score predicts poor survival in patients with newly diagnosed high-grade gliomas

Jie Zhang  1 , Qiuyan Xu  2 , Hua Zhang  3 , Yihong Zhang  4 , Yu Yang  5 , Huidan Luo  6 , Xiaoyan Lin  7 , Xingqin He  8 , Yonggao Mou  9 , Zhihuan Zhou  10 , Zhenqiang He  11
Affiliations

High preoperative albumin-bilirubin score predicts poor survival in patients with newly diagnosed high-grade gliomas

Jie Zhang et al. Transl Oncol. 2021 Apr.

Abstract

Objective: To determine the prognostic value of the preoperative Albumin-bilirubin (ALBI) score in high-grade glioma (HGG) patients.

Methods: A retrospective study of 194 HGG patients was conducted. ROC analysis was used to determine the optimal cut-off value of ALBI score. Univariate and multivariate analysis was performed to identify prognostic factors associated with progression free survival (PFS) and overall survival (OS). The resulting prognostic models were externally validated by a demographic-matched cohort of 130 HGG patients.

Results: Optimal cutoff value of ALBI score was -2.941. In training set, ALBI was correlated with age (P = 0.001), tumor location (P = 0.012) and adjuvant therapy (P = 0.016). Both PFS (8.27 vs. 18.40 months, P<0.001) and OS (13.93 vs. 27.57 months, P<0.001) were significantly worse in the ALBI-high group. Strikingly, patients in ALBI-low group had 56% decrease in the risk of tumor progression and 57% decrease in the risk of death relative to high ALBI. Multivariate analysis further identified ALBI score as an independent predictor for both PFS (HR=0.47, 95% CI 0.34, 0.66) and OS (HR=0.45, 95% CI 0.32, 0.63). The ALBI score remained independent prognostic value in the validation set for both PFS (P = 0.01) and OS (P = 0.007). Patients with low ALBI score had better PFS and OS in all subgroups by tumor grade and treatment modalities.

Conclusions: The preoperative ALBI score is a noninvasive and valuable prognostic marker for HGG patients.

Keywords: Albumin-bilirubin score; High-grade gliomas; Prognosis; Survival; Tumor progression.

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Conflict of interest statement

Declaration of Competing Interest The authors report no conflicts of interest in this work.

Figures

Fig 1
Fig. 1
. Kaplan-Meier survival curves of HGG patients in the training set (N = 194). According to the optimal cutoff value of ALBI score, patients were divided into two groups: preoperative ALBI score ≤ −2.941 as ALBI-low group and preoperative ALBI score > −2.941 as ALBI-high group. Both PFS (A) and OS (B) of patients in ALBI-low group were better than those in ALBI-high group (both P<0.001).
Fig 2
Fig. 2
. Kaplan-Meier survival curves of all HGG patients (N = 324). Patients in ALBI-low group had significantly longer PFS (A, P<0.001) and OS (B, P<0.001) than patients in ALBI-high group.
Fig 3
Fig. 3
. Kaplan-Meier survival curves of different HGG subgroups. Kaplan-Meier method and log-rank test were used to investigate differences in PFS and OS by preoperative ALBI group. Low ABLI level was significantly associated with better PFS and OS in subgroups of WHO Grade III gliomas (A-B), WHO Grade IV gliomas (C-D), patients received adjuvant radiotherapy and chemotherapy (E-F) and patients did not receive adjuvant radiotherapy and chemotherapy (G-H).
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