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Assessment of the Albumin-Bilirubin (ALBI) Grade as a Prognostic Indicator for Hepatocellular Carcinoma Patients Treated With Radioembolization

Gui, Bin, MD*; Weiner, Ashley A., MD, PhD; Nosher, John, MD; Lu, Shou-En, PhD§; Foltz, Gretchen M., MD; Hasan, Omar, MD; Kim, Seung K., MD; Gendel, Vyacheslav, MD; Mani, Naganathan B., MD; Carpizo, Darren R., MD, PhD; Saad, Nael E., MD; Kennedy, Timothy J., MD; Zuckerman, Darryl A., MD; Olsen, Jeffrey R., MD#; Parikh, Parag J., MD; Jabbour, Salma K., MD*

American Journal of Clinical Oncology: September 2018 - Volume 41 - Issue 9 - p 861–866
doi: 10.1097/COC.0000000000000384
Original Articles: Gastrointestinal

Objective: As the utility of Child-Pugh (C-P) class is limited by the subjectivity of ascites and encephalopathy, we evaluated a previously established objective method, the albumin-bilirubin (ALBI) grade, as a prognosticator for yttrium-90 radioembolization (RE) treatment for patients with hepatocellular carcinoma (HCC).

Materials and Methods: A total of 117 patients who received RE for HCC from 2 academic centers were reviewed and stratified by ALBI grade, C-P class, and Barcelona Clinic Liver Cancer stage. The overall survival (OS) according to these 3 criteria was evaluated by Kaplan-Meier survival analysis. The utilities of C-P class and ALBI grade as prognostic indicators were compared using the log-rank test. Multivariate Cox regression analysis was performed to identify additional predictive factors.

Results: Patients with ALBI grade 1 (n=49) had superior OS than those with ALBI grade 2 (n=65) (P=0.01). Meanwhile, no significant difference was observed in OS between C-P class A (n=100) and C-P class B (n=14) (P=0.11). For C-P class A patients, the ALBI grade (1 vs. 2) was able to stratify 2 clear and nonoverlapping subgroups with differing OS curves (P=0.03). Multivariate Cox regression test identified alanine transaminase, Barcelona Clinic Liver Cancer stage, and ALBI grade as the strongest prognostic factors for OS (P<0.10).

Conclusions: ALBI grade as a prognosticator has demonstrated clear survival discrimination that is superior to C-P class among HCC patients treated with RE, particularly within the subgroup of C-P class A patients. ALBI grade is useful for clinicians to make decisions as to whether RE should be recommended to patients with HCC.

*Department of Radiation Oncology

Division of Surgery, Rutgers Cancer Institute of New Jersey

Department of Radiology, Rutgers Robert Wood Johnson University Hospital, New Brunswick

§Department of Biostatistics, Rutgers School of Public Health, Piscataway, NJ

Department of Radiation Oncology, Washington University School of Medicine

Department of Radiology, Washington University, St Louis, MO

#Department of Radiation Oncology, University of Colorado, Denver, CO

B.G. and A.A.W. contributed equally.

P.J.P. has received grants from Sirtex. The grants are only for radiation dosimetry, not related to the submitted work. He has grants from Philips Healthcare, personal fees from Johnson & Johnson, grants and other financial support from Varian Medical System, Holaira Inc., and Medtronic/Covidien, outside the submitted work; J.R.O. reports grants and personal fees from Viewray Inc., outside the submitted work; D.R.C. reports personal fees from Z53 Therapeutics, outside the submitted work. None of these grants, personal fees, or other financial fees mentioned above is related to the submitted work. Other authors of this paper have no financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.

Reprints: Salma K. Jabbour, MD, Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ 08903. E-mail:

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