Korean J Gastroenterol.  2021 Mar;77(3):115-122. 10.4166/kjg.2020.148.

Effectiveness of Albumin-bilirubin Score as a Predictor of Post-hepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

• Park HJ
• Seo KI
• Kim SJ
• Lee SU
• Yun BC
• Han BH
• Shin DH
• Choi YI
• Moon HH

• KMID: 2514087
• DOI: http://doi.org/10.4166/kjg.2020.148

Abstract

Background/Aims
Post-hepatectomy liver failure (PHLF) is a major concern for patients with hepatocellular carcinoma (HCC) who have undergone liver resection. The albumin-bilirubin (ALBI) score is a novel model for assessing liver function. We aimed to investigate the effectiveness of the ALBI score as a predictor of PHLF in HCC patients who have undergone hepatectomy in South Korea.
Methods
Between January 2014 and November 2018, HCC patients who underwent hepatectomy and indocyanine retention rate at 15 min (ICG-R15) test were enrolled in this study.
Results
A total of 101 patients diagnosed with HCC underwent hepatectomy. Thirty-two patients (31.7%) experienced PHLF. The ALBI score (OR 2.83; 95% CI 1.22-6.55; p=0.015), ICG-R15 (OR 1.07; 95% CI 1.02-1.12; p=0.007) and ALBI grade (OR 2,86; 95% CI 1.08-7.58; p=0.035) were identified as independent predictors of PHLF by multivariable analysis. The area under the receiver operating characteristic curve of the ALBI score and ICG-R15 were 0.676 (95% CI 0.566-0.785) and 0.632 (95% CI 0.513-0.752), respectively. The optimal cutoff value of the ALBI score in predicting PHLF was -2.62, with a sensitivity of 75.0% and a specificity of 56.5%.
Conclusions
The ALBI score is an effective predictor of PHLF in patients with HCC, and its predictive ability is comparable to that of ICG-R15.

Keyword

Albumin-bilirubin; Indocyanine green rate at 15 min; Post-hepatectomy liver failure; Carcinoma; hepatocellular

Figure

• 

  Fig. 1 Flowchart of study population. HCC, hepatocellular carcinoma; TACE, transcatheter arterial chemoembolization.

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  Fig. 2 ROC curve analyses of ALBI score and ICG-R15 in predicting PHLF in the total cohort. ROC, receiver operation characteristic; PHLF, post-hepatectomy liver failure; ALBI, albumin-bilirubin; ICG-R15, indocyanine green retention rate at 15 minutes.

• 

  Fig. 3 ROC curve analyses of ALBI score and ICG-R15 in predicting PHLF in the minor hepatectomy group. ROC, receiver operation characteristic; PHLF, post-hepatectomy liver failure; ALBI, albumin-bilirubin; ICG-R15, indocyanine green retention rate at 15 minutes.

Reference

1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 2018; Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424. DOI: 10.3322/caac.21492. PMID: 30207593.

2. European Association for the Study of the Liver. 2019; Corrigendum to "EASL clinical practice guidelines: management of hepatocellular carcinoma" [J Hepatol 2018;69:182-236]. J Hepatol. 70:817. DOI: 10.1016/j.jhep.2019.01.020. PMID: 30739718.

3. Heimbach JK, Kulik LM, Finn RS, et al. 2018; AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 67:358–380. DOI: 10.1002/hep.29086. PMID: 28130846.

4. Omata M, Cheng AL, Kokudo N, et al. 2017; Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 11:317–370. DOI: 10.1007/s12072-017-9799-9. PMID: 28620797. PMCID: PMC5491694.

5. Hernaez R, Solà E, Moreau R, Ginès P. 2017; Acute-on-chronic liver failure: an update. Gut. 66:541–553. DOI: 10.1136/gutjnl-2016-312670. PMID: 28053053. PMCID: PMC5534763.

6. Mai RY, Wang YY, Bai T, et al. 2019; Combination of ALBI and APRI To predict post-hepatectomy liver failure after liver resection for HBV-related HCC patients. Cancer Manag Res. 11:8799–8806. DOI: 10.2147/CMAR.S213432. PMID: 31632139. PMCID: PMC6779592.

7. Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J. 1999; Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg. 229:210–215. DOI: 10.1097/00000658-199902000-00008. PMID: 10024102. PMCID: PMC1191633.

8. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. 2000; Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 191:38–46. DOI: 10.1016/S1072-7515(00)00261-1. PMID: 10898182.

9. Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM. 2004; National trends in the use and outcomes of hepatic resection. J Am Coll Surg. 199:31–38. DOI: 10.1016/j.jamcollsurg.2004.03.005. PMID: 15217626.

10. Rahbari NN, Garden OJ, Padbury R, et al. 2011; Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 149:713–724. DOI: 10.1016/j.surg.2010.10.001. PMID: 21236455.

11. Schreckenbach T, Liese J, Bechstein WO, Moench C. 2012; Posthepatectomy liver failure. Dig Surg. 29:79–85. DOI: 10.1159/000335741. PMID: 22441624.

12. Kauffmann R, Fong Y. 2014; Post-hepatectomy liver failure. Hepatobiliary Surg Nutr. 3:238–246. DOI: 10.3978/j.issn.2304-3881.2014.09.01. PMID: 25392835. PMCID: PMC4207837.

13. Iguchi K, Hatano E, Yamanaka K, Tanaka S, Taura K, Uemoto S. 2014; The impact of posthepatectomy liver failure on the recurrence of hepatocellular carcinoma. World J Surg. 38:150–158. DOI: 10.1007/s00268-013-2247-7. PMID: 24132820.

14. van Mierlo KM, Schaap FG, Dejong CH, Olde Damink SW. 2016; Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure. J Hepatol. 65:1217–1231. DOI: 10.1016/j.jhep.2016.06.006. PMID: 27312944.

15. van den Broek MA, Olde Damink SW, Dejong CH, et al. 2008; Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 28:767–780. DOI: 10.1111/j.1478-3231.2008.01777.x. PMID: 18647141.

16. Imamura H, Sano K, Sugawara Y, Kokudo N, Makuuchi M. 2005; Assessment of hepatic reserve for indication of hepatic resection: decision tree incorporating indocyanine green test. J Hepatobiliary Pancreat Surg. 12:16–22. DOI: 10.1007/s00534-004-0965-9. PMID: 15754094.

17. Durand F, Valla D. 2008; Assessment of prognosis of cirrhosis. Semin Liver Dis. 28:110–122. DOI: 10.1055/s-2008-1040325. PMID: 18293281.

18. Johnson PJ, Berhane S, Kagebayashi C, et al. 2015; Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 33:550–558. DOI: 10.1200/JCO.2014.57.9151. PMID: 25512453. PMCID: PMC4322258.

19. Kubota K, Makuuchi M, Kusaka K, et al. 1997; Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 26:1176–1181. DOI: 10.1053/jhep.1997.v26.pm0009362359. PMID: 9362359.

20. Sonohara F, Yamada S, Tanaka N, et al. 2018; Perioperative and prognostic implication of albumin-bilirubin-TNM score in Child-Pugh class A hepatocellular carcinoma. Ann Gastroenterol Surg. 3:65–74. DOI: 10.1002/ags3.12212. PMID: 30697612. PMCID: PMC6345730.

21. Chan AW, Chan RC, Wong GL, et al. 2015; New simple prognostic score for primary biliary cirrhosis: albumin-bilirubin score. J Gastroenterol Hepatol. 30:1391–1396. DOI: 10.1111/jgh.12938. PMID: 25753927.

22. Ma T, Li QS, Wang Y, et al. 2019; Value of pretransplant albumin-bilirubin score in predicting outcomes after liver transplantation. World J Gastroenterol. 25:1879–1889. DOI: 10.3748/wjg.v25.i15.1879. PMID: 31057301. PMCID: PMC6478615.

23. Zhang W, Liu C, Tan Y, et al. 2018; Albumin-bilirubin score for predicting post-transplant complications following adult-to-adult living donor liver transplantation. Ann Transplant. 23:639–646. DOI: 10.12659/AOT.910824. PMID: 30201946. PMCID: PMC6248303.

24. Li MX, Zhao H, Bi XY, et al. 2017; Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma: validation in a Chinese cohort. Hepatol Res. 47:731–741. DOI: 10.1111/hepr.12796. PMID: 27558521.

25. Zhang ZQ, Xiong L, Zhou JJ, et al. 2018; Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC. World J Surg Oncol. 16:208. DOI: 10.1186/s12957-018-1500-9. PMID: 30326907. PMCID: PMC6192221.

26. Andreatos N, Amini N, Gani F, et al. 2017; Albumin-bilirubin score: predicting short-term outcomes including bile leak and post-hepatectomy liver failure following hepatic resection. J Gastrointest Surg. 21:238–248. DOI: 10.1007/s11605-016-3246-4. PMID: 27619809.

27. Wang YY, Zhong JH, Su ZY, et al. 2016; Albumin-bilirubin versus Child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg. 103:725–734. DOI: 10.1002/bjs.10095. PMID: 27005482.

28. Zou H, Wen Y, Yuan K, Miao XY, Xiong L, Liu KJ. 2018; Combining albumin-bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients. Liver Int. 38:494–502. DOI: 10.1111/liv.13514. PMID: 28685924.

29. Zou H, Yang X, Li QL, Zhou QX, Xiong L, Wen Y. 2018; A comparative study of albumin-bilirubin score with Child-Pugh score, model for end-stage liver disease score and indocyanine green R15 in predicting posthepatectomy liver failure for hepatocellular carcinoma patients. Dig Dis. 36:236–243. DOI: 10.1159/000486590. PMID: 29495004.

30. Fagenson AM, Gleeson EM, Pitt HA, Lau KN. 2020; Albumin-bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg. 230:637–645. DOI: 10.1016/j.jamcollsurg.2019.12.007. PMID: 31954813.

31. Balzan S, Belghiti J, Farges O, et al. 2005; The "50-50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 242:824–829. DOI: 10.1097/01.sla.0000189131.90876.9e. PMID: 16327492. PMCID: PMC1409891.

32. Pol B, Campan P, Hardwigsen J, Botti G, Pons J, Le Treut YP. 1999; Morbidity of major hepatic resections: a 100-case prospective study. Eur J Surg. 165:446–453. DOI: 10.1080/110241599750006686. PMID: 10391161.

33. Chen X, Zhai J, Cai X, et al. 2012; Severity of portal hypertension and prediction of postoperative liver failure after liver resection in patients with Child-Pugh grade A cirrhosis. Br J Surg. 99:1701–1710. DOI: 10.1002/bjs.8951. PMID: 23132418.

34. Augustin S, Millán L, González A, et al. 2014; Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: a prospective study. J Hepatol. 60:561–569. DOI: 10.1016/j.jhep.2013.10.027. PMID: 24211744.

35. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. 1973; Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 60:646–649. DOI: 10.1002/bjs.1800600817. PMID: 4541913.

36. Butt AA, Ren Y, Lo Re V 3rd, Taddei TH, Kaplan DE. 2017; Comparing Child-Pugh, MELD, and FIB-4 to predict clinical outcomes in hepatitis C virus-infected persons: results from ERCHIVES. Clin Infect Dis. 65:64–72. DOI: 10.1093/cid/cix224. PMID: 28369305.

37. Omagari K, Ohba K, Kadokawa Y, et al. 2006; Comparison of the grade evaluated by "liver damage" of Liver Cancer Study Group of Japan and Child-Pugh classification in patients with hepatocellular carcinoma. Hepatol Res. 34:266–272. DOI: 10.1016/j.hepres.2005.05.010. PMID: 16460997.

38. Forner A, Llovet JM, Bruix J. 2012; Hepatocellular carcinoma. Lancet. 379:1245–1255. DOI: 10.1016/S0140-6736(11)61347-0. PMID: 29307467.

39. Bruix J, Reig M, Sherman M. 2016; Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma. Gastroenterology. 150:835–853. DOI: 10.1053/j.gastro.2015.12.041. PMID: 26795574.

40. Clavien PA, Petrowsky H, DeOliveira ML, Graf R. 2007; Strategies for safer liver surgery and partial liver transplantation. N Engl J Med. 356:1545–1559. DOI: 10.1056/NEJMra065156. PMID: 17429086.

41. Dong ZR, Zou J, Sun D, et al. 2017; Preoperative Albumin-bilirubin score for postoperative solitary hepatocellular carcinoma within the milan criteria and Child-Pugh A cirrhosis. J Cancer. 8:3862–3867. DOI: 10.7150/jca.21313. PMID: 29151974. PMCID: PMC5688940.