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J Clin Oncol. 2015 Feb 20;33(6):550-8. doi: 10.1200/JCO.2014.57.9151. Epub 2014 Dec 15.

Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade.

Author information

1
Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan. Philip.Johnson@liverpool.ac.uk.
2
Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan.

Abstract

PURPOSE:

Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade.

PATIENTS AND METHODS:

We developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501).

RESULTS:

The model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function.

CONCLUSION:

The ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.

PMID:
25512453
PMCID:
PMC4322258
DOI:
10.1200/JCO.2014.57.9151
[Indexed for MEDLINE]
Free PMC Article

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