A multicentre validation study based on easy albumin-bilirubin score: a new model for predicting postoperative complications and survival of hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DAI Junlong ¹ , LI Chuan ¹ , ZHANG Yu ² , XIE Fei ³ , YU Yu ⁴ , JIANG Kangyi ⁵ ,  WEN Tianfu ¹

1. Liver Transplantation Center, Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Organ Transplantation Center, Sichuan Academy of Medical Sciences (Sichuan Provincial People’s Hospital), Chinese Academy of Sciences, Chengdu 610072, P. R. China;
3. Department of Hepatobiliary and Pancreatic Surgery, The First People’s Hospital of Neijiang City, Neijiang, Sichuan 641000, P. R. China;
4. Department of Hepatopancreatobiliary Surgery, The Second People’s Hospital of Yibin City, Yibin, Sichuan 644000, P. R. China;
5. Department of Hepatobiliary Surgery, People’s Hospital of Leshan City, Leshan, Sichuan 614000, P. R. China;

Corresponding author：

WEN Tianfu, Email: wentianfu@scu.edu.cn

Keywords：

hepatocellular carcinoma; easy albumin-bilirubin score; hepatectomy; prognosis; complication

DOI：

10.7507/1007-9424.202110021

Video：

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Objective To evaluate the prognostic value of the easy albumin-bilirubin (EZ-ALBI) score for postoperative complications and long-term prognosis of hepatocellular carcinoma (HCC) patients. Methods The data on consecutive 1 822 HCC patients who underwent hepatectomy were obtained and retrospectively analyzed from five medical centers, including West China Hospital, Sichuan Provincial People’s Hospital, The First People’s Hospital of Neijiang City, The Second People’s Hospital of Yibin City, and People’s Hospital of Leshan City. Non-conditional logistic and Cox proportional hazards regression were used to evaluate the aspect on the postoperative complications and long-term prognosis. Results The patients in EZ-ALBI grade 2 had higher incidences of severe complication (Clavein-Dindo classification>2, P=0.001), post-hepatectomy liver failure (P=0.040), length of stay>10 d (P<0.001), perioperative transfusion (P<0.001), and 90 d mortality (P<0.001). The 1-, 3- and 5-year cumulative survival rates in EZ-ALBI grade 1 group were 85.5%, 67.0%, and 58.7% while in EZ-ALBI grade 2 group were 72.7%, 51.1%, and 39.8%. Multivariate Cox proportional hazards regression manifested that patients in EZ-ALBI grade 2 had a significantly worse overall survival [HR=1.24, 95%CI (1.04, 1.48), P=0.015]. Conclusion The EZ-ALBI score is an easy and feasible classifying method to predict postoperative complications and survival of HCC.

Citation： DAI Junlong, LI Chuan, ZHANG Yu, XIE Fei, YU Yu, JIANG Kangyi, WEN Tianfu. A multicentre validation study based on easy albumin-bilirubin score: a new model for predicting postoperative complications and survival of hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 881-886. doi: 10.7507/1007-9424.202110021 Copy

1.	Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology, 2004, 127(5 Suppl 1): S35-S50. doi: 10.1053/j.gastro.2004.09.014.
2.	Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut, 2020, 69(7): 1343-1352.
3.	Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
4.	Kok B, Abraldes JG. Child-Pugh Classification: time to abandon? Semin Liver Dis, 2019, 39(1): 96-103.
5.	Hoekstra LT, de Graaf W, Nibourg GA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg, 2013, 257(1): 27-36.
6.	Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol, 2015, 33(6): 550-558.
7.	Pinato DJ, Sharma R, Allara E, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol, 2017, 66(2): 338-346.
8.	Toyoda H, Lai PB, O’Beirne J, et al. Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade. Br J Cancer, 2016, 114(7): 744-750.
9.	Kariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI score for predicting hepatocellular carcinoma prognosis. Liver Cancer, 2020, 9(6): 734-743.
10.	Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology, 2018, 67(1): 358-380.
11.	Ho SY, Liu PH, Hsu CY, et al. Easy albumin-bilirubin score as a new prognostic predictor in hepatocellular carcinoma. Hepatol Res, 2021, 51(11): 1129-1138.
12.	Søreide JA, Deshpande R. Post hepatectomy liver failure (PHLF)-recent advances in prevention and clinical management. Eur J Surg Oncol, 2021, 47(2): 216-224.
13.	Tustumi F, Ernani L, Coelho FF, et al. Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis. HPB (Oxford), 2018, 20(12): 1109-1118.
14.	Ho SY, Liu PH, Hsu CY, et al. Comparison of twelve liver functional reserve models for outcome prediction in patients with hepatocellular carcinoma undergoing surgical resection. Sci Rep, 2018, 8(1): 4773. doi: 10.1038/s41598-018-22923-4.
15.	Fagenson AM, Gleeson EM, Pitt HA, et al. Albumin-bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg, 2020, 230(4): 637-645.
16.	Zou H, Wen Y, Yuan K, et al. Combining albumin-bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients. Liver Int, 2018, 38(3): 494-502.
17.	Xun Z, Liu C, Yu QQ, et al. Albumin-bilirubin score is associated with response to pegylated interferon and nucleos(t)ide analogues in chronic hepatitis B patients. Clin Chim Acta, 2020, 502: 120-127.
18.	Fujita K, Oura K, Yoneyama H, et al. Albumin-bilirubin score indicates liver fibrosis staging and prognosis in patients with chronic hepatitis C. Hepatol Res, 2019, 49(7): 731-742.
19.	Huang M, Shen S, Cai H, et al. Regional liver function analysis with gadoxetic acid-enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC. Eur Radiol, 2021, 31(7): 4720-4730.
20.	Torzilli G, Olivari N, Moroni E, et al. Contrast-enhanced intraoperative ultrasonography in surgery for hepatocellular carcinoma in cirrhosis. Liver Transpl, 2004, 10(2 Suppl 1): S34-S38. doi: 10.1002/lt.20050.
21.	Cho WR, Hung CH, Chen CH, et al. Ability of the post-operative ALBI grade to predict the outcomes of hepatocellular carcinoma after curative surgery. Sci Rep, 2020, 10(1): 7290. doi: 10.1038/s41598-020-64354-0.
22.	Hiraoka A, Kumada T, Michitaka K, et al. Usefulness of albumin-bilirubin grade for evaluation of prognosis of 2 584 Japanese patients with hepatocellular carcinoma. J Gastroenterol Hepatol, 2016, 31(5): 1031-1036.
23.	Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet, 2003, 362(9399): 1907-1917.
24.	Villanueva A. Hepatocellular carcinoma. N Engl J Med, 2019, 380(15): 1450-1462.

1. Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology, 2004, 127(5 Suppl 1): S35-S50. doi: 10.1053/j.gastro.2004.09.014.
2. Loomba R, Adams LA. Advances in non-invasive assessment of hepatic fibrosis. Gut, 2020, 69(7): 1343-1352.
3. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
4. Kok B, Abraldes JG. Child-Pugh Classification: time to abandon? Semin Liver Dis, 2019, 39(1): 96-103.
5. Hoekstra LT, de Graaf W, Nibourg GA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg, 2013, 257(1): 27-36.
6. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol, 2015, 33(6): 550-558.
7. Pinato DJ, Sharma R, Allara E, et al. The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma. J Hepatol, 2017, 66(2): 338-346.
8. Toyoda H, Lai PB, O’Beirne J, et al. Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade. Br J Cancer, 2016, 114(7): 744-750.
9. Kariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI score for predicting hepatocellular carcinoma prognosis. Liver Cancer, 2020, 9(6): 734-743.
10. Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology, 2018, 67(1): 358-380.
11. Ho SY, Liu PH, Hsu CY, et al. Easy albumin-bilirubin score as a new prognostic predictor in hepatocellular carcinoma. Hepatol Res, 2021, 51(11): 1129-1138.
12. Søreide JA, Deshpande R. Post hepatectomy liver failure (PHLF)-recent advances in prevention and clinical management. Eur J Surg Oncol, 2021, 47(2): 216-224.
13. Tustumi F, Ernani L, Coelho FF, et al. Preoperative strategies to improve resectability for hepatocellular carcinoma: a systematic review and meta-analysis. HPB (Oxford), 2018, 20(12): 1109-1118.
14. Ho SY, Liu PH, Hsu CY, et al. Comparison of twelve liver functional reserve models for outcome prediction in patients with hepatocellular carcinoma undergoing surgical resection. Sci Rep, 2018, 8(1): 4773. doi: 10.1038/s41598-018-22923-4.
15. Fagenson AM, Gleeson EM, Pitt HA, et al. Albumin-bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg, 2020, 230(4): 637-645.
16. Zou H, Wen Y, Yuan K, et al. Combining albumin-bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients. Liver Int, 2018, 38(3): 494-502.
17. Xun Z, Liu C, Yu QQ, et al. Albumin-bilirubin score is associated with response to pegylated interferon and nucleos(t)ide analogues in chronic hepatitis B patients. Clin Chim Acta, 2020, 502: 120-127.
18. Fujita K, Oura K, Yoneyama H, et al. Albumin-bilirubin score indicates liver fibrosis staging and prognosis in patients with chronic hepatitis C. Hepatol Res, 2019, 49(7): 731-742.
19. Huang M, Shen S, Cai H, et al. Regional liver function analysis with gadoxetic acid-enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC. Eur Radiol, 2021, 31(7): 4720-4730.
20. Torzilli G, Olivari N, Moroni E, et al. Contrast-enhanced intraoperative ultrasonography in surgery for hepatocellular carcinoma in cirrhosis. Liver Transpl, 2004, 10(2 Suppl 1): S34-S38. doi: 10.1002/lt.20050.
21. Cho WR, Hung CH, Chen CH, et al. Ability of the post-operative ALBI grade to predict the outcomes of hepatocellular carcinoma after curative surgery. Sci Rep, 2020, 10(1): 7290. doi: 10.1038/s41598-020-64354-0.
22. Hiraoka A, Kumada T, Michitaka K, et al. Usefulness of albumin-bilirubin grade for evaluation of prognosis of 2 584 Japanese patients with hepatocellular carcinoma. J Gastroenterol Hepatol, 2016, 31(5): 1031-1036.
23. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet, 2003, 362(9399): 1907-1917.
24. Villanueva A. Hepatocellular carcinoma. N Engl J Med, 2019, 380(15): 1450-1462.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A multicentre validation study based on easy albumin-bilirubin score: a new model for predicting postoperative complications and survival of hepatocellular carcinoma

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