Ryan Hickey1, Samdeep Mouli1, Laura Kulik2, Kush Desai1, Bartley Thornburg1, Daniel Ganger2, Talia Baker3, Michael Abecassis3, Joseph Ralph Kallini1, Ahmed Gabr1, Vanessa L Gates1, Al B Benson Iii4, Robert J Lewandowski1, Riad Salem5. 1. Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. 2. Department of Radiology, Divisions of Hepatology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. 3. Department of Medicine, and Division of Transplantation, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. 4. Hematology and Oncology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. 5. Section of Interventional Radiology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611; Department of Radiology, Divisions of Hepatology, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611; Department of Medicine, and Division of Transplantation, Comprehensive Transplant Center, Department of Surgery, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611. Electronic address: r-salem@northwestern.edu.
Abstract
PURPOSE: To assess validity of albumin-bilirubin (ALBI) grade as a predictor of survival in patients undergoing transarterial embolization for hepatocellular carcinoma. MATERIALS AND METHODS: Baseline albumin and bilirubin values of 765 consecutive patients treated with conventional transarterial chemoembolization or yttrium-90 ((90)Y) radioembolization at a single institution were used to determine liver function according to ALBI grade. Survival outcomes were stratified by ALBI grade using Kaplan-Meier and stratified by Child-Pugh (C-P) class and Barcelona Clinic Liver Cancer (BCLC) stage. Discriminatory ability was assessed by C-index. RESULTS: For 428 patients receiving (90)Y radioembolization, ALBI grade yielded distinct survival curves (P < .001). When stratified by C-P class and BCLC stage, ALBI grade revealed different survival outcomes for C-P B (P = .001), BCLC A (P < .001), BCLC B (P = .001), and BCLC C (P < .001). When substratified by BCLC stage, ALBI grade was a better discriminator of survival than C-P class (C-index 0.792, 0.763, respectively). For 337 patients receiving transarterial chemoembolization, ALBI grade yielded distinct survival curves (P < .001). When stratified by C-P class and BCLC stage, ALBI grade provided distinct survival curves for C-P B (P = .02), BCLC B (P = .001), and BCLC C (P = .02). When substratified by BCLC stage, ALBI grade was a better discriminator of survival than C-P class (C-index 0.739, 0.735, respectively). CONCLUSIONS: ALBI grade outperforms C-P class at discriminating survival in patients receiving transarterial chemoembolization or (90)Y radioembolization. ALBI grade is also valuable in patients with moderate liver dysfunction and BCLC B disease.
PURPOSE: To assess validity of albumin-bilirubin (ALBI) grade as a predictor of survival in patients undergoing transarterial embolization for hepatocellular carcinoma. MATERIALS AND METHODS: Baseline albumin and bilirubin values of 765 consecutive patients treated with conventional transarterial chemoembolization or yttrium-90 ((90)Y) radioembolization at a single institution were used to determine liver function according to ALBI grade. Survival outcomes were stratified by ALBI grade using Kaplan-Meier and stratified by Child-Pugh (C-P) class and Barcelona Clinic Liver Cancer (BCLC) stage. Discriminatory ability was assessed by C-index. RESULTS: For 428 patients receiving (90)Y radioembolization, ALBI grade yielded distinct survival curves (P < .001). When stratified by C-P class and BCLC stage, ALBI grade revealed different survival outcomes for C-P B (P = .001), BCLC A (P < .001), BCLC B (P = .001), and BCLC C (P < .001). When substratified by BCLC stage, ALBI grade was a better discriminator of survival than C-P class (C-index 0.792, 0.763, respectively). For 337 patients receiving transarterial chemoembolization, ALBI grade yielded distinct survival curves (P < .001). When stratified by C-P class and BCLC stage, ALBI grade provided distinct survival curves for C-P B (P = .02), BCLC B (P = .001), and BCLC C (P = .02). When substratified by BCLC stage, ALBI grade was a better discriminator of survival than C-P class (C-index 0.739, 0.735, respectively). CONCLUSIONS:ALBI grade outperforms C-P class at discriminating survival in patients receiving transarterial chemoembolization or (90)Y radioembolization. ALBI grade is also valuable in patients with moderate liver dysfunction and BCLC B disease.
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