Anthony W H Chan1, Takshi Kumada2, Hidenori Toyoda2, Toshifumi Tada2, Charing C N Chong3, Frankie K F Mo4, Winnie Yeo4, Philip J Johnson5, Paul B S Lai2,5, Anthony T C Chan4, Ka-Fai To1,6,7, Stephen L Chan4,6. 1. Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong. 2. Department of Gastroenterology Ogaki Municipal Hospital, Ogaki, Japan. 3. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong kong. 4. Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong kong. 5. Department of Molecular and Clinical Cancer Medicine, University of Liverpool Liverpool, UK. 6. Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong kong. 7. Li Ka Shing Institute of Health Sciences, Sir YK Pao Centre for Cancer, The Chinese University of Hong Kong, Hong Kong.
Abstract
BACKGROUND AND AIMS: The albumin-bilirubin (ALBI) grade is a recently reported, simpler, more objective, and evidence-based alternative to the Child-Pugh (CP) score for hepatocellular carcinoma (HCC). We aimed to study whether ALBI grade could substitute for CP score in Barcelona Clinic Liver Cancer (BCLC) for HCC. METHODS: An international multicentre cohort (n = 3696) was accrued to compare the prognostic performance of the CP-based and ALBI-based BCLC system, in terms of homogeneity, discriminatory ability, and monotonicity of gradients that were numerically reflected by homogeneity likelihood, linear trend chi-squares, and c-indices, respectively. RESULTS: The ALBI grade performed as well as CP score when integrated into the BCLC staging system in terms of predicting clinical outcome of HCC regardless of regions, etiology, and treatment options. CP-based and ALBI-based BCLC systems were highly concordant with weighted kappa value of 0.917. All restaged patients showed significantly different clinical outcomes compared with their original stage classification. In particular, ALBI-based BCLC upstaged 83 (2.2%) patients from lower CP-based BC LC stages to ALBI-based BCLC stage D, whose median overall survival was only 3 months. CONCLUSIONS: The overall prognostic performance of ALBI-based and CP-based BCLC systems was similar. It also potentially allows more precise patient selection for clinical trials on systemic agents.
BACKGROUND AND AIMS: The albumin-bilirubin (ALBI) grade is a recently reported, simpler, more objective, and evidence-based alternative to the Child-Pugh (CP) score for hepatocellular carcinoma (HCC). We aimed to study whether ALBI grade could substitute for CP score in Barcelona Clinic Liver Cancer (BCLC) for HCC. METHODS: An international multicentre cohort (n = 3696) was accrued to compare the prognostic performance of the CP-based and ALBI-based BCLC system, in terms of homogeneity, discriminatory ability, and monotonicity of gradients that were numerically reflected by homogeneity likelihood, linear trend chi-squares, and c-indices, respectively. RESULTS: The ALBI grade performed as well as CP score when integrated into the BCLC staging system in terms of predicting clinical outcome of HCC regardless of regions, etiology, and treatment options. CP-based and ALBI-based BCLC systems were highly concordant with weighted kappa value of 0.917. All restaged patients showed significantly different clinical outcomes compared with their original stage classification. In particular, ALBI-based BCLC upstaged 83 (2.2%) patients from lower CP-based BC LC stages to ALBI-based BCLC stage D, whose median overall survival was only 3 months. CONCLUSIONS: The overall prognostic performance of ALBI-based and CP-based BCLC systems was similar. It also potentially allows more precise patient selection for clinical trials on systemic agents.
Authors: Nicole Bernardi; Marcio F Chedid; Tomaz J M Grezzana-Filho; Aljamir D Chedid; Marcelo A Pinto; Ian Leipnitz; João E Prediger; Carolina Prediger; Ariane N Backes; Thais O Hammes; Lea T Guerra; Alexandre de Araujo; Mario R Alvares-da-Silva; Cleber R P Kruel Journal: Dig Dis Sci Date: 2019-01-14 Impact factor: 3.199
Authors: Nikolaos Andreatos; Neda Amini; Faiz Gani; Georgios A Margonis; Kazunari Sasaki; Vanessa M Thompson; David J Bentrem; Bruce L Hall; Henry A Pitt; Ana Wilson; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2016-09-12 Impact factor: 3.452