Introduction A new evidence based model, the Albumin-Bilirubin (ALBI) grade,1has been recently proposed for assessing liver function in patients with hepatocellular carcinoma (HCC). We aimed to evaluate the impact of ALBI in predicting decompensation and survival after liver resection (LR) for HCC.
Method Consecutive patients undergoing resection for HCC between 2011–2014 at the Royal Free Hospital were evaluated. Demographic, clinical data and histopathological features of resected tumour were collected. Patients underwent HVPG and ICG clearance measurement to evaluate potential resectability. ALBI score was calculated pre and post-operatively. Patients were divided into 3 categories (ALBI 1,2,3) according to published ALBI score cut-offs. Cox regression was used to identify predictors of decompensation and survival post LR.
Results 48 patients were included with a median post LR follow up 17 months (1–54): male 42(87.5%), mean age 63 years (28–83). Median HVPG 6 mmHg (2–15), median ICG PDR 18.2 (6.1–29.4), median ICG R15 6.5 (1.2–19.2). All patients had a Child Pugh score A5.
46 (96%) had a pre-LR ALBI grade 1 and 2 (4%) had an ALBI grade 2. Clinically significant portal hypertension (HVPG ≥10 mmHg) was found in 11 (23%) patients. Eight (19%) patients had an ICG PDR <15, while three (6%) had ICG R15 >15. Thirty (62.5%) patients underwent an anatomical resection, while 18 (37.5%) had a wedge resection.
Post-LR decompensation was observed in 5(10%) patients: ascites n = 4, encephalopathy n = 1 at a median of 10 days post-LR.
12(25%) patients had HCC recurrence after a mean time of 11 months (5–28). 7(15%) died after a mean follow up of 15 months (1–40), 3 of them due to tumour recurrence. Patients with 1 HCC <30 mm had 100% survival (mean follow up 20 months, range 9–32). 2 patients with pre-LR ALBI grade 2 died after 7 and 11 months due to HCC recurrence and decompensated cirrhosis, respectively.
Cox regression analysis of pre LR variables (HVPG, ICG, CPS, ALBI, HCC size) showed that the only factor associated with survival was pre-LR ALBI score (p = 0.019).
Conclusion ALBI, an evidence based prognostic score specific to HCC, provides significant information regarding LR outcome in patients with HCC, independently of HVPG, ICG clearance and Child Pugh Score.
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;33(6):550–8
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