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Chen L, Tan C, Li Q, Ma Z, Wu M, Tan X, Wu T, Liu J, Wang J. Assessment of the albumin-bilirubin score in breast cancer patients with liver metastasis after surgery. Heliyon 2023; 9:e21772. [PMID: 38027616 PMCID: PMC10643261 DOI: 10.1016/j.heliyon.2023.e21772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aims to investigate the potential prognostic value of albumin-bilirubin (ALBI) score in breast cancer patients with liver metastasis after surgery. Methods This was a retrospective study of 178 breast cancer patients with liver metastasis after surgery. ALBI score was calculated by the following formula: (log10 bilirubin × 0.66) - (albumin × 0.085). The optimal cutoff value of ALBI score was assessed by X-tile. The clinical influence of ALBI score on survival outcomes using Kaplan-Meier method, Log-rank test, Cox proportional hazards regression model. The calibration curves, decision curve analysis and time-dependent ROC curve were used to assess the predictive performance of the nomogram's models. Results The classifications of 178 breast cancer patients with liver metastasis after surgery were as follows: low ALBI score group (<-3.36) vs. high ALBI score group (≥-3.36). The Cox proportional hazards regression model indicated that ALBI score was a potential predictor. Kaplan-Meier survival curve performed that the median disease free survival (p = 0.0029) and overall survival (p<0.0001) in low ALBI score group were longer than in high ALBI score group. The ALBI-based nomograms had good predictive performance. Conclusions The ALBI score has high prognostic ability for survival time in breast cancer with liver metastasis after surgery. These models will be valuable in discriminating patients at high risks of liver metastasis.
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Affiliation(s)
- Li Chen
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
| | - Chunlei Tan
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, 150081, PR China
| | - Qingwen Li
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei 430030, PR China
| | - Zhibo Ma
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei 430030, PR China
| | - Meng Wu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei 430030, PR China
| | - Xiaosheng Tan
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation, Ministry of Education, NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, Hubei 430030, PR China
| | - Tiangen Wu
- Department of Hepatobiliary&Pancreatic Surgery, Zhongnan Hospital of Wuhan University,Wuhan, Hubei, 430071, PR China
| | - Jinwen Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, PR China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, PR China
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Azili C, Tamam S, Benk MS, Deryol R, Culcu S, Unal AE. Preoperative ALBI grade predicts mortality in patients undergoing curative surgery for pancreatic head cancer. Medicine (Baltimore) 2023; 102:e35069. [PMID: 37682123 PMCID: PMC10489451 DOI: 10.1097/md.0000000000035069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
The clinical significance of the albumin-bilirubin (ALBI) grade in patients with pancreatic head cancer (PHC) undergoing surgery is unknown. Preoperative ALBI grade is believed to be influenced by tumor burden. This study aimed to develop and validate the ALBI grade as a preoperative prognostic model for predicting the survival of patients with PHC. This is a retrospective study of Whipple procedures performed on PHC patients between January 2013 and December 2022. ALBI grade was compared to age, gender, type of operation, presence of complications, type of complications, Clavien-Dindo classification, total bilirubin levels, and albumin levels. Of the series, 46 (41.1%) of the 112 patients were female, while 66 (58.9%) were male. The rate of complications following Whipple procedures was 36.6% (n = 41). The overall mortality hazard ratio increased significantly with increasing ALBI grades (HR: 1538, hazard ratio mean: -1602). Hospital mortality increased 2.84 times as the ALBI grade increased. The model's accuracy of 88.4% showed that the ALBI grade directly affected both the overall mortality rate and the hospital rate. But there was no statistically significant difference between the ALBI grade and other variables. Multivariate regression analysis identified the preoperative ALBI grade as an independent predictor of mortality (P = .006). To the best of our knowledge, this is the first study to identify preoperative ALBI grade as an independent predictor of survival in PHC. It was found that the ALBI grade of -1602 was a new grading system that would be more predictive of mortality in PHC.
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Affiliation(s)
- Cem Azili
- Department of General Surgery, Division of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selim Tamam
- Department of General Surgery, Division of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Sah Benk
- Department of General Surgery, Division of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Riza Deryol
- Department of General Surgery, Division of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serdar Culcu
- Department of General Surgery, Division of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ali Ekrem Unal
- Department of General Surgery, Division of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
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Deng M, Li S, Wang Q, Zhao R, Zou J, Lin W, Mei J, Wei W, Guo R. Real-world outcomes of patients with advanced intrahepatic cholangiocarcinoma treated with programmed cell death protein-1-targeted immunotherapy. Ann Med 2022; 54:803-811. [PMID: 35272564 PMCID: PMC8920361 DOI: 10.1080/07853890.2022.2048416] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE There is a lack of effective treatment to improve the prognosis of intrahepatic cholangiocarcinoma (ICC). Programmed cell death protein-1 (PD-1)-targeted immunotherapy has shown promising results in a variety of malignant tumours. However, in patients with advanced ICC, the safety and efficacy of anti-PD-1 agents remain unclear. METHODS Forty-two advanced ICC patients treated with anti-PD-1 agents from August 2018 to December 2020 were retrospectively analyzed. Tumour response, overall survival (OS), progression-free survival (PFS), and time to tumour progression (TTP) were evaluated. Adverse events were also recorded. RESULTS The median duration of follow-up was 12.1 months, and the median time of treatment was 6.7 months for all patients. The median OS, median PFS, and median TTP for the whole cohort were 19.3 months, 11.6 months, and 11.6 months, respectively. The overall response rate (ORR) and disease control rate (DCR) for the whole cohort were 23.8% and 85.7%, respectively. Of the 42 evaluable individuals, two (4.8%) had hyperprogressive disease. The most common adverse events (AEs) were pain (n = 6; 14.3%), anorexia (n = 4; 9.5%), hypertension (n = 4; 9.5%), pyrexia (n = 3; 7.1%), cough (n = 3; 7.1%), and hypothyroidism (n = 3; 7.1%). The median OS of patients with albumin-bilirubin (ALBI) grade 1 was longer than that of patients with ALBI grade 2 (19.3 months vs. 14.7 months). The median PFS did not show a significant difference between ALBI grade 1 and grade 2 patients (13.6 months vs. 6.9 months). CONCLUSIONS PD-1-targeted immunotherapy showed promising efficacy and safety in advanced ICC patients.Key messagesPD-1-targeted immunotherapy is a safe and effective treatment for advanced ICC patients.This study provides therapeutic strategy for advanced ICC patients.
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Affiliation(s)
- Min Deng
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shaohua Li
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qiaoxuan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rongce Zhao
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jingwen Zou
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wenping Lin
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jie Mei
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Wei
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rongping Guo
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Tong J, Liu P, Ji M, Wang Y, Xue Q, Yang JJ, Zhou CM. Machine Learning Can Predict Total Death After Radiofrequency Ablation in Liver Cancer Patients. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2021; 15:11795549211000017. [PMID: 33854400 PMCID: PMC8013536 DOI: 10.1177/11795549211000017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/07/2021] [Indexed: 01/10/2023]
Abstract
Objective: Over 1 million new cases of hepatocellular carcinoma (HCC) are diagnosed worldwide every year. Its prognosis remains poor, and the 5-year survival rate in all disease stages is estimated to be between 10% and 20%. Radiofrequency ablation (RFA) has become an important local treatment for liver cancer, and machine learning (ML) can provide many shortcuts for liver cancer medical research. Therefore, we explore the role of ML in predicting the total mortality of liver cancer patients undergoing RFA. Methods: This study is a secondary analysis of public database data from 578 liver cancer patients. We used Python for ML to establish the prognosis model. Results: The results showed that the 5 most important factors were platelet count (PLT), Alpha-fetoprotein (AFP), age, tumor size, and total bilirubin, respectively. Results of the total death model for liver cancer patients in test group: among the 5 algorithm models, the highest accuracy rate was that of gbm (0.681), followed by the Logistic algorithm (0.672); among the 5 algorithms, area under the curve (AUC) values, from high to low, were Logistic (0.738), DecisionTree (0.723), gbm (0.717), GradientBoosting (0.714), and Forest (0.693); Among the 5 algorithms, gbm had the highest precision rate (0.721), followed by the Logistic algorithm (0.714). Among the 5 algorithms, DecisionTree had the highest recall rate (0.642), followed by the GradientBoosting algorithm (0.571). Conclusion: Machine learning can predict total death after RFA in liver cancer patients. Therefore, ML research has great potential for both personalized treatment and prognosis of liver cancer.
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Affiliation(s)
- Jianhua Tong
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Panmiao Liu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Muhuo Ji
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiong Xue
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Cheng-Mao Zhou
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Wang ZX, Peng W, Zhang XY, Wen TF, Li C. Prognostic significance of postoperative change of PALBI grade for patients with hepatocellular carcinoma after hepatectomy. Medicine (Baltimore) 2021; 100:e24476. [PMID: 33725934 PMCID: PMC7982202 DOI: 10.1097/md.0000000000024476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/01/2021] [Indexed: 02/05/2023] Open
Abstract
The platelet-albumin-bilirubin (PALBI) grade plays critical role in evaluating liver function. However, the change of PALBI grade from the preoperative to postoperative period in predicting patient outcomes after hepatectomy remains unclear.A total of 489 HCC patients who underwent hepatectomy in West China Hospital between January, 2010 and June, 2016 were analyzed retrospectively.ΔPALBI grade was calculated by PALBI grade at the first postoperative month - preoperative PALBI grade.ΔPALBI >0 was considered as stable; otherwise, worse PALBI grade was considered. Kaplan- Meier method and Cox proportional hazard regression analyses were performed for survival analysis. Prognostic model was constructed by nomogram method.Three hundred forty two patients and 147 patients were classified into training group and validation group, respectively. In the training group, results from Cox model suggested that worse PALBI grade (HR 1.328, 95% CI 1.010-1.746, P = .042), tumor size (HR 1.460, 95% CI 1.058-2.015, P = .021), microvascular invasion (MVI, HR 1.802, 95% CI 1.205-2.695, P < .001), and high alpha-fetoprotein level (AFP, HR 1.364, 95% CI 1.044-1.781, P = .023) negatively influenced postoperative recurrence. Similarly, worse PALBI grade (HR 1.403, 95% CI 1.020-1.930, P = .038), tumor size (HR 1.708, 95% CI 1.157-2.520, P = .007), MVI (HR 1.914, 95% CI 1.375-2.663, P < .001), and presence of cirrhosis (HR 1.773, 95% CI 1.226-2.564, P = .002) had negatively impacts on overall survival. Patients with worse PALBI grade had worse recurrence free (RFS) and overall survival (OS). The prognostic model incorporating the change of PALBI grade constructed in training group and tested in the validation group could perform well in predicting the outcomes.Postoperative change of PALBI grade was independently risk factor related with prognosis. Prognostic model incorporating the change of PALBI grade might be a useful index to predict the prognosis of HCC patients following hepatectomy.
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Affiliation(s)
- Zheng-Xia Wang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University
- Department of Hepatobiliary Pancreatic Surgery, Chengdu Second People's Hospital, Chengdu, China
| | - Wei Peng
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University
| | - Xiao-Yun Zhang
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University
| | - Tian-Fu Wen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University
| | - Chuan Li
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University
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Kumada T, Toyoda H, Tada T, Yasuda S, Tanaka J. Changes in Background Liver Function in Patients with Hepatocellular Carcinoma over 30 Years: Comparison of Child-Pugh Classification and Albumin Bilirubin Grade. Liver Cancer 2020; 9:518-528. [PMID: 33083278 PMCID: PMC7548913 DOI: 10.1159/000507933] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/11/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Background liver function in patients with hepatocellular carcinoma (HCC) has improved remarkably with advances in various treatments. Recently, the Child-Pugh classification (CPC) system has been recognized as limited in its ability to assess patients with good hepatic reserve. We compared the albumin-bilirubin (ALBI) grade, which is suitable for a more detailed evaluation of patients with good liver function, with CPC over a 30-year period. METHODS A total of 2,347 patients were analyzed. Patients were stratified by year of diagnosis into 6 groups: Group A (1990-1994, n = 376), Group B (1995-1999, n = 434), Group C (2000-2004, n = 438), Group D (2005-2009, n = 444), Group E (2010-2014, n = 392), and Group F (2015-2018, n = 263). We compared ALBI grade and CPC across the groups. RESULTS The prevalence of patients with CPC A at diagnosis increased throughout the study period, reaching nearly 80% in Groups E and F (p < 0.001). By contrast, the percentage of patients with ALBI grade 1 disease remained approximately 50% in Groups E and F (p < 0.001). Modified ALBI (mALBI) grade 2a corresponds to patients with CPC A who have poor hepatic function. There were significant survival differences between patients with mALBI grade 1 versus 2a, 1 versus 2b, and 2a versus 2b disease, respectively (p < 0.0001), in patients with CPC A. CONCLUSIONS CPC is not suitable for assessing patients with recently diagnosed HCC and good remnant hepatic function. In such patients with HCC, the prognosis can be stratified by ALBI grade rather than CPC.
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Affiliation(s)
- Takashi Kumada
- Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan,*Takashi Kumada, MD, Department of Nursing, Faculty of Nursing, Gifu Kyoritsu University, 5-50, Kitagata-cho, Ogaki-shi, Gifu-ken 503-8550 (Japan),
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Toshifumi Tada
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Satoshi Yasuda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
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WANG X, ZHANG Z, WU Z, SUN Y, ZHANG Y, GONG M, JI F. [Prediction model of mid-term fatality risk after radical resection in patients with hepatocellular carcinoma based on ALBI-grade]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:375-382. [PMID: 32762166 PMCID: PMC8800794 DOI: 10.3785/j.issn.1008-9292.2020.06.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To establish a clinical prediction model of the mid-term fatality risk after radical resection in patients with primary hepatocellular carcinoma (HCC) based on the albumin-bilirubin (ALBI) grade and to assess its prediction value. METHODS Clinical data of 533 patients who received HCC radical resection in Jinhua Hospital of Zhejiang University, Jinhua People's Hospital, Jinhua Hospital of Traditional Chinese Medicine and Jinhua Guangfu Hospital from January 2010 to August 2016 were retrospectively reviewed. In the training group ( n=407), Cox model was used to screen the clinical risk factors of postoperative death, and a predictive model based on ALBI grade was established and then examined in the validation group ( n=126). The value of the prediction model was assessed by ROC curve and calibration curve; the prediction results of the model were visualized by the nomogram for the convenience of clinical use. RESULTS Cox model showed that ALT ≥ 80 U/L, tumor maximum diameter ≥ 5 cm, portal vein tumor thrombus and ALBI grade 2 were independent risk factors for the prognosis of patients with HCC radical resection. The prognosis index (PI) was 0.550×ALT+0.512×ALBI grade+0.872×maximum tumor diameter+1.377×portal vein tumor thrombus. The AUCs for predicting the risk of death in 12, 36 and 60 months were 0.872, 0.814 and 0.810, respectively (all P < 0.01), and the goodness of fit ( r 2) of the established model were 0.953, 0.976 and 0.994. AUC of the established model for predicting risk of death in 36 months after resection was 0.814, which was higher than those of ALBI (AUC=0.683), BCLC (AUC=0.713), CLIP (AUC=0.689), Child-Pugh (AUC=0.645), TNM (AUC=0.612) ( P < 0.05 or P < 0.01). CONCLUSIONS ALT ≥ 80 U/L, maximum tumor diameter ≥ 5 cm, portal vein tumor thrombus and ALBI grade 2 are independent risk factors of patients after HCC resection, and ALBI grade-based prediction model is satisfactory in prediction of mid-term death risk of the patients.
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Lee SK, Song MJ, Kim SH, Park M. Comparing various scoring system for predicting overall survival according to treatment modalities in hepatocellular carcinoma focused on Platelet-albumin-bilirubin (PALBI) and albumin-bilirubin (ALBI) grade: A nationwide cohort study. PLoS One 2019; 14:e0216173. [PMID: 31048923 PMCID: PMC6497276 DOI: 10.1371/journal.pone.0216173] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND We evaluated the ability of various grading scales including platelet-albumin-bilirubin (PALBI) and albumin-bilirubin (ALBI) grades to predict overall survival (OS) according to treatment modality in patients with hepatocellular carcinoma (HCC). METHODS The cohort of 6,669 patients with HCC was selected randomly from the 2008-2012 national cohort of the Korean Central Cancer Registry. The OS of 6,507 of these patients was evaluated using the Child-Turcotte-Pugh (CTP) class, Model for End-stage Liver Disease (MELD) score, and ALBI and PALBI grades. RESULTS The patient's mean age was 59.7 years. The most patients were hepatitis B virus (63.4%) and CTP class A (71.8%). The median OS durations of PALBI grade1 (38.4%), grade2 (33.2%), and grade3 (28.4%) patients were 81, 30, and 5 months, respectively (P<0.001). The PALBI grade had a larger area under the receiver operator characteristic curve (AUC) than did the CTP class, MELD score, and ALBI grade (overall AUC: 0.675 vs. 0.633, 0.645, and 0.642, respectively; P < 0.001). Moreover, the PALBI and ALBI grades enabled sub-classification of CTP A patients (P < 0.001). In a multivariate analysis, the PALBI and ALBI grades were significant risk factors for OS (P < 0.05). According to treatment modality, the PALBI grade was predictive of OS in patients receiving transarterial chemoembolization or supportive care. The ALBI grade was predictive of OS in patients undergoing surgical resection or radiofrequency ablation. CONCLUSION The PALBI and ALBI grades are more reliable for accessing liver function and predicting OS in patients with HCC. Moreover, according to treatment modality, appropriate use of the ALBI and PALBI grades will enable accurate determination of the prognosis of patients with HCC.
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Affiliation(s)
- Soon Kyu Lee
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myeong Jun Song
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Korean Liver Cancer Study Group, Seoul, Republic of Korea
- Ministry of Health and Welfare, Korea Central Cancer Registry, Goyang-Si, Republic of Korea
- * E-mail:
| | - Seok Hwan Kim
- Division of Hepatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Misun Park
- Department of Biostatics, Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Albumin-Bilirubin and Platelet-Albumin-Bilirubin Grades Accurately Predict Overall Survival in High-Risk Patients Undergoing Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma. J Vasc Interv Radiol 2017; 28:1224-1231.e2. [PMID: 28688815 DOI: 10.1016/j.jvir.2017.05.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades in predicting overall survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma (HCC). MATERIALS AND METHODS This single-center retrospective study included 180 high-risk patients (142 men, 59 y ± 9) between April 2007 and January 2015. Patients were considered high-risk based on laboratory abnormalities before the procedure (bilirubin > 2.0 mg/dL, albumin < 3.5 mg/dL, platelet count < 60,000/mL, creatinine > 1.2 mg/dL); presence of ascites, encephalopathy, portal vein thrombus, or transjugular intrahepatic portosystemic shunt; or Model for End-Stage Liver Disease score > 15. Serum albumin, bilirubin, and platelet values were used to determine ALBI and PALBI grades. Overall survival was stratified by ALBI and PALBI grades with substratification by Child-Pugh class (CPC) and Barcelona Liver Clinic Cancer (BCLC) stage using Kaplan-Meier analysis. C-index was used to determine discriminatory ability and survival prediction accuracy. RESULTS Median survival for 79 ALBI grade 2 patients and 101 ALBI grade 3 patients was 20.3 and 10.7 months, respectively (P < .0001). Median survival for 30 PALBI grade 2 and 144 PALBI grade 3 patients was 20.3 and 12.9 months, respectively (P = .0667). Substratification yielded distinct ALBI grade survival curves for CPC B (P = .0022, C-index 0.892), BCLC A (P = .0308, C-index 0.887), and BCLC C (P = .0287, C-index 0.839). PALBI grade demonstrated distinct survival curves for BCLC A (P = 0.0229, C-index 0.869). CPC yielded distinct survival curves for the entire cohort (P = .0019) but not when substratified by BCLC stage (all P > .05). CONCLUSIONS ALBI and PALBI grades are accurate survival metrics in high-risk patients undergoing conventional transarterial chemoembolization for HCC. Use of these scores allows for more refined survival stratification within CPC and BCLC stage.
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