David J Pinato1, Rohini Sharma2, Elias Allara3, Clarence Yen2, Tadaaki Arizumi4, Keiichi Kubota5, Dominik Bettinger6, Jeong Won Jang7, Carlo Smirne8, Young Woon Kim7, Masatoshi Kudo4, Jessica Howell2, Ramya Ramaswami2, Michela E Burlone8, Vito Guerra9, Robert Thimme6, Mitsuru Ishizuka5, Justin Stebbing2, Mario Pirisi8, Brian I Carr10. 1. Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK. Electronic address: david.pinato@imperial.ac.uk. 2. Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS London, UK. 3. NIHR Blood and Transplant Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK. 4. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan. 5. Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi 321-0293, Japan. 6. Department of Medicine II, University Hospital Freiburg, Freiburg, Germany. 7. Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Seoul, Republic of Korea. 8. Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, Novara, Italy. 9. IRCCS De Bellis, National Institute for Digestive Diseases, Castellana Grotte, Italy. 10. Izmir Biomedicine and Genome Centre, Dokuz Eylul University, Izmir, Turkey.
Abstract
BACKGROUND & AIMS: Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC) due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in hepatocellular carcinoma, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate stage HCC, where OS is highly heterogeneous. METHODS: We evaluated the prognostic accuracy of the ALBI grade in estimating OS in a large, multi-centre study of 2426 patients, including a large proportion of intermediate stage patients treated with chemoembolization (n=1461) accrued from Europe, the United States and Asia. RESULTS: Analysis of survival by primary treatment modality confirmed the ALBI grade as a significant predictor of patient OS after surgical resection (p<0.001), transarterial chemoembolization (p<0.001) and sorafenib (p<0.001). Stratification by Barcelona Clinic Liver Cancer stage confirmed the independent prognostic value of the ALBI across the diverse stages of the disease, geographical regions of origin and time of recruitment to the study (p<0.001). CONCLUSIONS: In this large, multi-centre retrospective study, the ALBI grade satisfied the criteria for accuracy and reproducibility following statistical validation in Eastern and Western HCC patients, including those treated with chemoembolization. Consideration should be given to the ALBI grade as a stratifying biomarker of liver reserve in routine clinical practice. LAY SUMMARY: Liver failure is a key determinant influencing the natural history of hepatocellular carcinoma (HCC). In this large multi-centre study we externally validate a novel biomarker of liver functional reserve, the ALBI grade, across all the stages of HCC.
BACKGROUND & AIMS: Overall survival (OS) is a composite clinical endpoint in hepatocellular carcinoma (HCC) due to the mutual influence of cirrhosis and active malignancy in dictating patient's mortality. The ALBI grade is a recently described index of liver dysfunction in hepatocellular carcinoma, based solely on albumin and bilirubin levels. Whilst accurate, this score lacks cross-validation, especially in intermediate stage HCC, where OS is highly heterogeneous. METHODS: We evaluated the prognostic accuracy of the ALBI grade in estimating OS in a large, multi-centre study of 2426 patients, including a large proportion of intermediate stage patients treated with chemoembolization (n=1461) accrued from Europe, the United States and Asia. RESULTS: Analysis of survival by primary treatment modality confirmed the ALBI grade as a significant predictor of patient OS after surgical resection (p<0.001), transarterial chemoembolization (p<0.001) and sorafenib (p<0.001). Stratification by Barcelona Clinic Liver Cancer stage confirmed the independent prognostic value of the ALBI across the diverse stages of the disease, geographical regions of origin and time of recruitment to the study (p<0.001). CONCLUSIONS: In this large, multi-centre retrospective study, the ALBI grade satisfied the criteria for accuracy and reproducibility following statistical validation in Eastern and Western HCC patients, including those treated with chemoembolization. Consideration should be given to the ALBI grade as a stratifying biomarker of liver reserve in routine clinical practice. LAY SUMMARY: Liver failure is a key determinant influencing the natural history of hepatocellular carcinoma (HCC). In this large multi-centre study we externally validate a novel biomarker of liver functional reserve, the ALBI grade, across all the stages of HCC.
Authors: Eleni Gkika; Dominik Bettinger; Leo Krafft; Michael Schultheiss; Hannes Philipp Neeff; Lars Maruschke; Michaela Schulenburg; Sonja Adebahr; Simon Kirste; Ursula Nestle; Robert Thimme; Anca-Ligia Grosu; Thomas Baptist Brunner Journal: Strahlenther Onkol Date: 2018-01-10 Impact factor: 3.621
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: Josep M Llovet; Robin Kate Kelley; Augusto Villanueva; Amit G Singal; Eli Pikarsky; Sasan Roayaie; Riccardo Lencioni; Kazuhiko Koike; Jessica Zucman-Rossi; Richard S Finn Journal: Nat Rev Dis Primers Date: 2021-01-21 Impact factor: 52.329
Authors: Eleni Gkika; Iosif Strouthos; Simon Kirste; Sonja Adebahr; Michael Schultheiss; Dominik Bettinger; Ralph Fritsch; Volker Brass; Lars Maruschke; Hannes Philipp Neeff; Sven Arke Lang; Ursula Nestle; Anca-Ligia Grosu; Thomas Baptist Brunner Journal: Strahlenther Onkol Date: 2018-10-23 Impact factor: 3.621