Shu-Yein Ho1,2,3, Po-Hong Liu3,4, Chia-Yang Hsu3,5, Chih-Chieh Ko3,6, Yi-Hsiang Huang3,6,7, Chien-Wei Su3,6, Cheng-Yuan Hsia3,8, Ping-Hsing Tsai2,9, Shih-Jie Chou2,9, Rheun-Chuan Lee3,10, Ming-Chih Hou3,6, Teh-Ia Huo2,3,9. 1. Division of Gastroenterology and Hepatology, Min-Sheng General Hospital, Taoyuan, Taiwan. 2. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. 3. School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. 4. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 5. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. 6. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 7. Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. 8. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan. 10. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Liver functional reserve is a major prognostic determinant in patients with hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score is an objective method to assess the severity of cirrhosis in this setting. However, the calculation of ALBI score is complex and difficult to access in clinical practice. Recently, the EZ (easy)-ALBI score was proposed as an alternative biomarker of liver injury. We aimed to evaluate the prognostic role of EZ-ALBI score in HCC from early to advanced stages. METHODS: A total of 3,794 newly diagnosed HCC patients were prospectively enrolled and retrospectively analyzed. Independent prognostic predictors were determined by using the multivariate Cox proportional hazards model. RESULTS: The EZ-ALBI score showed good correlation with ALBI score (correlation coefficient: 0.965, p< 0.001). The correlation of EZ-ALBI score was highly preserved in different Child-Turcotte-Pugh (CTP) classification, treatment modality, and BCLC stage (correlation coefficients: 0.90-0.97). In the Cox multivariate analysis, age > 65 years, male, serum α-fetoprotein > 20 ng/mL, large or multiple tumors, total tumor volume > 100 cm3 , vascular invasion or distant metastasis, ascites, poor performance status, EZ-ALBI grade 2 and 3, and non-curative treatments were independently associated with increased mortality (all p< 0.05). Moreover, EZ-ALBI grade can stratify long-term survival in patients with different CTP class, treatment strategy and BCLC stage. CONCLUSIONS: The EZ-ALBI score is an easy and feasible method to evaluate liver functional reserve. As a new prognostic biomarker in HCC, the predictive power of EZ-ALBI grade is independent across different cancer stage and treatment modality. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
BACKGROUND: Liver functional reserve is a major prognostic determinant in patients with hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score is an objective method to assess the severity of cirrhosis in this setting. However, the calculation of ALBI score is complex and difficult to access in clinical practice. Recently, the EZ (easy)-ALBI score was proposed as an alternative biomarker of liver injury. We aimed to evaluate the prognostic role of EZ-ALBI score in HCC from early to advanced stages. METHODS: A total of 3,794 newly diagnosed HCC patients were prospectively enrolled and retrospectively analyzed. Independent prognostic predictors were determined by using the multivariate Cox proportional hazards model. RESULTS: The EZ-ALBI score showed good correlation with ALBI score (correlation coefficient: 0.965, p< 0.001). The correlation of EZ-ALBI score was highly preserved in different Child-Turcotte-Pugh (CTP) classification, treatment modality, and BCLC stage (correlation coefficients: 0.90-0.97). In the Cox multivariate analysis, age > 65 years, male, serum α-fetoprotein > 20 ng/mL, large or multiple tumors, total tumor volume > 100 cm3 , vascular invasion or distant metastasis, ascites, poor performance status, EZ-ALBI grade 2 and 3, and non-curative treatments were independently associated with increased mortality (all p< 0.05). Moreover, EZ-ALBI grade can stratify long-term survival in patients with different CTP class, treatment strategy and BCLC stage. CONCLUSIONS: The EZ-ALBI score is an easy and feasible method to evaluate liver functional reserve. As a new prognostic biomarker in HCC, the predictive power of EZ-ALBI grade is independent across different cancer stage and treatment modality. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.