Introduction BCLC 0/A stage HCC patients are considered candidates for curative treatments. Within the BCLC classification, liver function is assessed by CP score despite this score not being derived from patients with HCC. ALBI is a novel evidence based score derived from a large cohort of HCC patients and has been shown to define different prognostic groups even within CP A.1We studied the performance of ALBI score in a well characterised cohort of patients with BCLC 0/A stage HCC to determine if ALBI score impacted on prognosis.
Method Consecutive patients with BCLC 0/A HCC, evaluated between 2010–2014 at the Royal Free Hospital were included. All patients had a performance score of 0 and were undergoing evaluation for potential resection. Patients were considered resectable if they had HVPG ≤10 mmHg or HVPG ≥10 mmHg with good liver function as assessed by ICG clearance. ALBI score was calculated at the time of HVPG and ICG clearance measurement and divided into 3 grades as per published cutoffs. Kaplan Meier and Cox regression analysis were used to assess the impact of ALBI on survival.
Results 67 patients were included: 64 (95.5%) were CP A, 3 (4.5%) were CP B. 60 (89%) had uninodular tumour and 7 (10.4%) multifocal (≤3 tumours ≤30 mm). 46 (69%) underwent resection, 4 (6%) RFA, 9 (14%) TAE, 3 (5%) OLT, 3 (5%) either no treatment or undergoing evaluation. Median follow up was 9 months (13–54). 10 (15%) patients died during follow up. Cause of death was HCC-related n = 4, liver failure n = 4, non-liver related n = 2. In Kaplan Meier analysis CP score was not associated with difference in survival. Cox regression analysis revealed ALBI score as the only significant factor related to survival and was independent of CP score and treatment allocation (p = 0.002, OR=15, 95% CI=3–80). Of patients with ALBI grade 1, 44 (83%) were considered suitable and underwent resection vs only 2 (14%) with ALBI 2. One-year survival was 88% in patients with ALBI grade 1 and 43% in patients with ALBI grade 2 (p = 0.002).
Conclusion In patients with BCLC 0/A stage HCC ALBI score clearly defines patients with different prognosis regardless of Child Pugh score and treatment allocation. ALBI grade 2 patients are very rarely suitable candidates for resection. ALBI score is more informative than Child Pugh score in patients with early stage HCC and may be useful in determining treatment allocation.
Disclosure of interest None Declared.
Johnson PJ, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015 Feb 20;33(6):550–8