The role of albumin-bilirubin grade in determining the outcomes of patients with very early stage hepatocellular carcinoma
Chung-Yu Chang 1 , Cheng-Yi Wei, Ping-Hsien Chen, Ming-Chih Hou, Yee Chao, Gar-Yang Chau, Rheun-Chuan Lee, Yi-Hsiang Huang, Yu-Hui Su, Jaw-Ching Wu, Chien-Wei Su
Affiliations
Affiliation
1
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC Division of Gastroenterology and Hepatology, Department of Medicine, West Garden Hospital, Taiwan, ROC Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC Department of Accounting, School of Business, Soochow University, Taipei, Taiwan, ROC Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Cancer Progression Research Center, National Yang-Ming University, Taipei, Taiwan, ROC Hospitalist Ward, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
PMID: 33433133 DOI: 10.1097/JCMA.0000000000000482
Abstract
Background: Patients with hepatocellular carcinoma (HCC) and with a single tumor <2 cm in size are classified as having Barcelona Clinic Liver Cancer (BCLC) stage 0 HCC. We aimed to investigate the role of the albumin-bilirubin (ALBI) grade in predicting outcomes in patients with BCLC stage 0 HCC.
Methods: We retrospectively enrolled patients with BCLC stage 0 HCC in Taipei Veterans General Hospital from 2007 to 2015. Prognostic factors were analyzed using a Cox proportional hazards model and propensity score matching (PSM) analysis.
Results: There were 420 patients enrolled, including 207 with ALBI grade 1, and 213 with ALBI grade 2 or 3. After a median follow-up of 60.0 months (interquartile range, 37.2-84.6 months), 179 patients died. The cumulative 5-year overall survival (OS) rates were 80.6% in patients with ALBI grade 1 and 53.7% in those with ALBI grade 2 or 3, respectively (p <0.001). Multivariate analysis showed that age >65 years, negative hepatitis B surface in serum, creatinine >1.0 mg/dL, platelet count ≤105/mm3, tumor size >1.5 cm, non-surgical resection (SR) therapy, and higher ALBI grade were independent risk factors related to poor OS. Patients who underwent SR had a better OS and recurrence-free survival than those who received radiofrequency ablation, which was confirmed by a multivariate analysis and PSM analysis.
Conclusion: The ALBI grade can determine OS for patients with BCLC stage 0 HCC. SR can also provide a better outcome than non-surgical treatment.