Validation of Modified ALBI Grade for More Detailed Assessment of Hepatic Function in Hepatocellular Carcinoma Patients: A Multicenter Analysis

Overview

Journal Liver Cancer

Date 2019 Apr 26

PMID 31019902

Citations 106

Authors

Atsushi Hiraoka

Takashi Kumada

Kunihiko Tsuji

Koichi Takaguchi

Ei Itobayashi

Kazuya Kariyama

Hironori Ochi

Kazuto Tajiri

Masashi Hirooka

Noritomo Shimada

Toru Ishikawa

Yoshihiko Tachi

Toshifumi Tada

Hidenori Toyoda

Kazuhiro Nouso

Kouji Joko

Yoichi Hiasa

Kojiro Michitaka

Masatoshi Kudo

Affiliations

Soon will be listed here.

Abstract

Background/aim: The frequency of hepatocellular carcinoma (HCC) in patients with good hepatic reserve function has been increasing in Japan along with the progression of antiviral therapies and aging of the society. We evaluated the usefulness of modified albumin-bilirubin (ALBI) grade as a tool for assessment of hepatic reserve function.

Materials/methods: We enrolled 6,649 naïve HCC patients treated from 2000 to 2017 and divided them into training (Ehime Prefecture group: E group, = 2,357) and validation (validation group: V group, = 4,292) cohorts. Child-Pugh classification and ALBI and modified ALBI (mALBI) grading were compared using with Japan Integrated Staging (JIS), ALBI-TNM (ALBI-T), and mALBI-T scores, which were calculated based on TNM stage and each assessment tool, retrospectively.

Results: In the E group, Akaike's Information Criterion (AIC) and c-index values for mALBI-T (13,725.2/0.744) were better as compared to those of ALBI-T (13,772.6/0.733) and JIS score (13,874.7/0.720), with similar results observed in the V group (mALBI-T: 27,727.4/0.760; ALBI-T: 27,817.8/0.750; JIS: 27,807.5/0.748). Although there were some significant differences between the groups with regard to clinical background factors (age, etiology, tumor size, tumor number, treatment modalities), for all patients the AIC and c-index values of mALBI-T (45,327.1/0.755) were also better than those of ALBI-T (45,467.7/0.744) and JIS scores (45,555.8/0.739), indicating its superior stratification ability and prognostic predictive value in patients with HCC.

Conclusion: The detailed stratification ability of mALBI grade for hepatic reserve function is suitable for the recent trend of HCC patients, while mALBI-T may provide a more accurate predictive value than existing total staging scoring systems.

Citing Articles

Evaluation of prognostic scores in patients with HCC undergoing first-line immunotherapy with atezolizumab and bevacizumab.

Gairing S, Mildenberger P, Gile J, Artusa F, Scheiner B, Leyh C JHEP Rep. 2025; 7(3):101295.

PMID: 40059970 PMC: 11889551. DOI: 10.1016/j.jhepr.2024.101295.

Treatment outcomes of hepatectomy and systemic chemotherapy based on oncological resectability criteria for hepatocellular carcinoma.

Komatsu S, Yano Y, Ishihara N, Kido M, Gon H, Fukushima K Ann Gastroenterol Surg. 2025; 9(2):235-243.

PMID: 40046525 PMC: 11877347. DOI: 10.1002/ags3.12893.

Transarterial Chemoembolization for Patients With Hepatocellular Carcinoma Using Miriplatin Without the Need for Hydration.

Fujita K, Takuma K, Oura K, Tadokoro T, Morishita A, Himoto T Clin Transl Sci. 2025; 18(3):e70182.

PMID: 40040451 PMC: 11880689. DOI: 10.1111/cts.70182.

Effect of Nutritional Index on Lenvatinib Treatment Retention Rates in Unresectable Hepatocellular Carcinoma.

Wakamatsu R, Nakayama M, Wakamatsu A, Yamashita Y, Suto H, Katsuragawa M In Vivo. 2025; 39(2):988-999.

PMID: 40010999 PMC: 11884448. DOI: 10.21873/invivo.13904.

Blood pressure elevations post-lenvatinib treatment in hepatocellular carcinoma: a potential marker for better prognosis.

Shibata K, Akasaki Y, Tokushige A, Nitta M, Kawasoe S, Kubozono T Hypertens Res. 2025; .

PMID: 39966607 DOI: 10.1038/s41440-025-02149-4.

References

Kudo M, Chung H, Osaki Y . Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol. 2003; 38(3):207-15. DOI: 10.1007/s005350300038. View

Omata M, Nishiguchi S, Ueno Y, Mochizuki H, Izumi N, Ikeda F . Sofosbuvir plus ribavirin in Japanese patients with chronic genotype 2 HCV infection: an open-label, phase 3 trial. J Viral Hepat. 2014; 21(11):762-8. DOI: 10.1111/jvh.12312. View

Hiraoka A, Kumada T, Hirooka M, Tsuji K, Itobayashi E, Kariyama K . A better method for assessment of hepatic function in hepatocellular carcinoma patients treated with radiofrequency ablation: Usefulness of albumin-bilirubin grade. Hepatol Res. 2017; 48(3):E61-E67. DOI: 10.1111/hepr.12927. View

Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T . Criteria for safe hepatic resection. Am J Surg. 1995; 169(6):589-94. DOI: 10.1016/s0002-9610(99)80227-x. View

Omata M, Cheng A, Kokudo N, Kudo M, Lee J, Jia J . Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017; 11(4):317-370. PMC: 5491694. DOI: 10.1007/s12072-017-9799-9. View

Ogawa E, Furusyo N, Nomura H, Dohmen K, Higashi N, Takahashi K . NS5A resistance-associated variants undermine the effectiveness of ledipasvir and sofosbuvir for cirrhotic patients infected with HCV genotype 1b. J Gastroenterol. 2016; 52(7):845-854. DOI: 10.1007/s00535-016-1290-1. View

Shao Y, Liu T, Lee Y, Hsu C, Cheng A . Modified CLIP with objective liver reserve assessment retains prognosis prediction for patients with advanced hepatocellular carcinoma. J Gastroenterol Hepatol. 2016; 31(7):1336-41. DOI: 10.1111/jgh.13312. View

Pugh R, Murray-Lyon I, Dawson J, Pietroni M, Williams R . Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60(8):646-9. DOI: 10.1002/bjs.1800600817. View

Hiraoka A, Horiike N, Yamashita Y, Koizumi Y, Doi K, Yamamoto Y . Efficacy of radiofrequency ablation therapy compared to surgical resection in 164 patients in Japan with single hepatocellular carcinoma smaller than 3 cm, along with report of complications. Hepatogastroenterology. 2009; 55(88):2171-4. View

10.

Sano K, Ichikawa T, Motosugi U, Sou H, Muhi A, Matsuda M . Imaging study of early hepatocellular carcinoma: usefulness of gadoxetic acid-enhanced MR imaging. Radiology. 2011; 261(3):834-44. DOI: 10.1148/radiol.11101840. View

11.

Hiraoka A, Kumada T, Kudo M, Hirooka M, Tsuji K, Itobayashi E . Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications. Liver Cancer. 2017; 6(3):204-215. PMC: 5473065. DOI: 10.1159/000452846. View

12.

Hiraoka A, Michitaka K, Kumagi T, Kurose K, Uehara T, Hirooka M . Efficacy of lamivudine therapy for decompensated liver cirrhosis due to hepatitis B virus with or without hepatocellular carcinoma. Oncol Rep. 2005; 13(6):1159-63. View

13.

Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H . Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol. 2011; 107(4):569-77. PMC: 3321437. DOI: 10.1038/ajg.2011.425. View

14.

Kokudo N, Hasegawa K, Akahane M, Igaki H, Izumi N, Ichida T . Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma: The Japan Society of Hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res. 2015; 45(2). DOI: 10.1111/hepr.12464. View

15.

Hiraoka A, Hiasa Y, Onji M, Michitaka K . New contrast enhanced ultrasonography agent: impact of Sonazoid on radiofrequency ablation. J Gastroenterol Hepatol. 2011; 26(4):616-8. DOI: 10.1111/j.1440-1746.2011.06678.x. View

16.

Asahina Y, Tsuchiya K, Tamaki N, Hirayama I, Tanaka T, Sato M . Effect of aging on risk for hepatocellular carcinoma in chronic hepatitis C virus infection. Hepatology. 2010; 52(2):518-27. DOI: 10.1002/hep.23691. View

17.

Hiraoka A, Ichiryu M, Tazuya N, Ochi H, Tanabe A, Nakahara H . Clinical translation in the treatment of hepatocellular carcinoma following the introduction of contrast-enhanced ultrasonography with Sonazoid. Oncol Lett. 2012; 1(1):57-61. PMC: 3436383. DOI: 10.3892/ol_00000010. View

18.

Di Martino M, Marin D, Guerrisi A, Baski M, Galati F, Rossi M . Intraindividual comparison of gadoxetate disodium-enhanced MR imaging and 64-section multidetector CT in the Detection of hepatocellular carcinoma in patients with cirrhosis. Radiology. 2010; 256(3):806-16. DOI: 10.1148/radiol.10091334. View

19.

Hiraoka A, Hidaka S, Shimizu Y, Utsunomiya H, Imai Y, Tatsukawa H . Recent trends of Japanese hepatocellular carcinoma due to HCV in aging society. Hepatogastroenterology. 2011; 59(118):1893-5. DOI: 10.5754/hge11732. View

20.

Hosaka T, Suzuki F, Kobayashi M, Seko Y, Kawamura Y, Sezaki H . Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection. Hepatology. 2012; 58(1):98-107. DOI: 10.1002/hep.26180. View