Atsushi Hiraoka1, Kojiro Michitaka1, Takashi Kumada2, Namiki Izumi3, Masumi Kadoya4, Norihiro Kokudo5, Shoji Kubo6, Yutaka Matsuyama7, Osamu Nakashima8, Michiie Sakamoto9, Tadatoshi Takayama10, Takashi Kokudo11, Kosuke Kashiwabara12, Masatoshi Kudo13. 1. Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama. 2. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki. 3. Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo. 4. Department of Radiology, Shinshu University School of Medicine, Matsumoto. 5. National Center for Global Health and Medicine, Tokyo. 6. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka. 7. Department of Biostatistics, School of Public Health, University of Tokyo, Tokyo. 8. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume. 9. Department of Pathology, Keio University School of Medicine. 10. Department of Digestive Surgery, Nihon University School of Medicine and Hepato-Biliary-Pancreatic Surgery Division. 11. Department of Surgery, Graduate School of Medicine. 12. Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo. 13. Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Osaka, Japan.
Abstract
BACKGROUND/AIM: Recently, albumin-bilirubin (ALBI) scoring/grading, consisting of only albumin and total bilirubin, has been proposed. We examined the efficacy of this grading system for determining hepatic function in patients with hepatocellular carcinoma (HCC). METHODS/MATERIALS: The prognoses of 46,681 HCC patients based on results obtained from a nationwide survey conducted in Japan from 2001 to 2007 were evaluated using (1) Japan Integrated Staging (JIS), consisting of Child-Pugh classification and TNM staging (TNM), (2) modified JIS (m-JIS), consisting of liver damage grading and TNM, and (3) ALBI-TNM (ALBI-T), consisting of ALBI grading and TNM, and the results were compared. A subanalysis was also performed to define a cutoff value for ALBI scores for a more detailed stratification of hepatic function. RESULTS: ALBI-T, JIS, and m-JIS each showed good capacity for the stratification of prognoses. Although the Akaike information criterion for ALBI-T was nearly equal to that for JIS and m-JIS, the Kaplan-Meier curves and median survival times obtained with ALBI-T were always superior to the corresponding scores. When the indocyanine green retention test (<30%) was used as an additional cutoff value for ALBI score (-2.270, area under the curve 0.828) to divide ALBI grade into 4 levels (modified ALBI [mALBI] grade), mALBI grade was able to stratify the prognosis of patients at any TNM stage in order of grade. Modified ALBI-T (mALBI-T), using mALBI grading and TNM, produced a more detailed stratification for prognosis. CONCLUSION: The predictive value for prognosis of ALBI-T was found to be equal to that of JIS and m-JIS. In addition, mALBI grading and mALBI-T, as proposed in the present study, might provide a more detailed assessment of the hepatic function and prognosis of HCC patients.
BACKGROUND/AIM: Recently, albumin-bilirubin (ALBI) scoring/grading, consisting of only albumin and total bilirubin, has been proposed. We examined the efficacy of this grading system for determining hepatic function in patients with hepatocellular carcinoma (HCC). METHODS/MATERIALS: The prognoses of 46,681 HCC patients based on results obtained from a nationwide survey conducted in Japan from 2001 to 2007 were evaluated using (1) Japan Integrated Staging (JIS), consisting of Child-Pugh classification and TNM staging (TNM), (2) modified JIS (m-JIS), consisting of liver damage grading and TNM, and (3) ALBI-TNM (ALBI-T), consisting of ALBI grading and TNM, and the results were compared. A subanalysis was also performed to define a cutoff value for ALBI scores for a more detailed stratification of hepatic function. RESULTS: ALBI-T, JIS, and m-JIS each showed good capacity for the stratification of prognoses. Although the Akaike information criterion for ALBI-T was nearly equal to that for JIS and m-JIS, the Kaplan-Meier curves and median survival times obtained with ALBI-T were always superior to the corresponding scores. When the indocyanine green retention test (<30%) was used as an additional cutoff value for ALBI score (-2.270, area under the curve 0.828) to divide ALBI grade into 4 levels (modified ALBI [mALBI] grade), mALBI grade was able to stratify the prognosis of patients at any TNM stage in order of grade. Modified ALBI-T (mALBI-T), using mALBI grading and TNM, produced a more detailed stratification for prognosis. CONCLUSION: The predictive value for prognosis of ALBI-T was found to be equal to that of JIS and m-JIS. In addition, mALBI grading and mALBI-T, as proposed in the present study, might provide a more detailed assessment of the hepatic function and prognosis of HCC patients.
Authors: Sarah Berhane; Hidenori Toyoda; Toshifumi Tada; Takashi Kumada; Chiaki Kagebayashi; Shinji Satomura; Nora Schweitzer; Arndt Vogel; Michael P Manns; Julia Benckert; Thomas Berg; Maria Ebker; Jan Best; Alexander Dechêne; Guido Gerken; Joerg F Schlaak; Arndt Weinmann; Marcus A Wörns; Peter Galle; Winnie Yeo; Frankie Mo; Stephen L Chan; Helen Reeves; Trevor Cox; Philip Johnson Journal: Clin Gastroenterol Hepatol Date: 2016-01-13 Impact factor: 11.382