The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis
1Gastroenterology Department, Monash Medical Centre, Melbourne, Australia. Gauri.Mishra@monashhealth.org.
2School of Clinical Sciences, Monash University, Melbourne, Australia. Gauri.Mishra@monashhealth.org.
3School of Clinical Sciences, Monash University, Melbourne, Australia.
4Gastroenterology Department, Alfred Health, Melbourne, Australia.
5Gastroenterology Department, Monash Medical Centre, Melbourne, Australia.
6The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney, Australia.
7Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
8Gastroenterology Centre, Ehime Prefectural Central Hospital, Matsuyama, Japan.
9Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
10Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
11Internal Medicine, University of Texas Southwestern Medical Centre, Dallas, Texas, USA.
12Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
Abstract
Purpose: Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies.
Methods: Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software.
Results: Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol-related liver disease were significant in the ALBI grade 3 group (P < 0.001).
Conclusions: High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.