Gauri Mishra1,2, Ammar Majeed3,4, Anouk Dev5,3, Guy D Eslick6, David J Pinato7, Hirofumi Izumoto, Atsushi Hiraoka8, Teh-Ia Huo9,10, Po-Hong Liu11, Philip J Johnson12, Stuart K Roberts3,4. 1. Gastroenterology Department, Monash Medical Centre, Melbourne, Australia. Gauri.Mishra@monashhealth.org. 2. School of Clinical Sciences, Monash University, Melbourne, Australia. Gauri.Mishra@monashhealth.org. 3. School of Clinical Sciences, Monash University, Melbourne, Australia. 4. Gastroenterology Department, Alfred Health, Melbourne, Australia. 5. Gastroenterology Department, Monash Medical Centre, Melbourne, Australia. 6. The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney, Australia. 7. Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK. 8. Gastroenterology Centre, Ehime Prefectural Central Hospital, Matsuyama, Japan. 9. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. 10. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan. 11. Internal Medicine, University of Texas Southwestern Medical Centre, Dallas, Texas, USA. 12. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
Abstract
PURPOSE: Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies. METHODS: Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software. RESULTS: Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol-related liver disease were significant in the ALBI grade 3 group (P < 0.001). CONCLUSIONS: High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.
PURPOSE: Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies. METHODS: Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software. RESULTS: Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol-related liver disease were significant in the ALBI grade 3 group (P < 0.001). CONCLUSIONS: High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.
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