Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2019; 11(6): 542-552
Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.542
Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma
Omar Elshaarawy, Alzhraa Alkhatib, Mostafa Elhelbawy, Asmaa Gomaa, Naglaa Allam, Ayman Alsebaey, Eman Rewisha, Imam Waked
Omar Elshaarawy, Alzhraa Alkhatib, Mostafa Elhelbawy, Asmaa Gomaa, Naglaa Allam, Ayman Alsebaey, Eman Rewisha, Imam Waked, Departemnt of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Menoufia 3511, Egypt
Author contributions: All authors contributed to the writing of the manuscript; Elshaarawy O, Alkhatib A and Elhelbawy M collected the data; Elshaarawy O, Gomaa A, Allam N, Rewisha E and Waked I revised and edited the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Liver Institute, Menoufia University.
Informed consent statement: Informed written consent was granted from all patients.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article are reported.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Omar Elshaarawy, MBChB, MSc, Attending Doctor, Departemnt of Hepatology, Gastroenterology and Liver Transplantation, National Liver Institute, Menoufia University, Meleg Road, Menoufia 3511, Egypt. oelshaarawy@liver.menofia.edu.eg
Telephone: +20-10-06603345
Received: March 12, 2019
Peer-review started: March 12, 2019
First decision: April 10, 2019
Revised: May 16, 2019
Accepted: June 17, 2019
Article in press: June 17, 2019
Published online: June 27, 2019
Processing time: 108 Days and 20.5 Hours
Abstract
BACKGROUND

An ideal staging system for hepatocellular carcinoma (HCC) should rely on the hepatic reserve function and tumor burden. With the improvement in diagnostic and treatment strategies for HCC, in addition to recent treatment of viral hepatitis, finding a suitable assessment tool for hepatic reserve has become mandatory.

AIM

To validate a recently proposed modified albumin-bilirubin-TNM (mALBI-T) grade as a prognostic model for patients with HCC in Egypt.

METHODS

For patients diagnosed with HCC, Child-Turcotte-Pugh (CTP) score, Barcelona Clinic Liver Cancer (BCLC) stage, albumin-bilirubin (ALBI), plateltet-albumin–bilirubin (PALBI), ALBI-based BCLC, ALBI-T and mALBI-T grades were estimated. Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive. Overall survival and received treatments were determined. Survival data were analyzed.

RESULTS

A total of 1910 patients were included (mean age, 57 years; 1575 males). At presentation, 50.6% had CTP A, 36.1% had CTP B and 13.4 % had CTP C; 12% had ALBI grade 1, 62.3% had ALBI grade 2 and 24.7% had ALBI grade 3. Overall median survival was 13 mo; survival was better in patients with ALBI 1 than in those with ALBI 2 and 3 (28.6 vs 14 and 5.8 mo, respectively, P < 0.001). Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2, 3, 4 and 5 (P < 0.001). The modified ALBI-T showed better stratification and significant improvement in prediction of survival.

CONCLUSION

ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage. mALBI-T is a better prognostic model in patients with HCC.

Keywords: Staging; Hepatocellular carcinoma; Albumin-bilirubin grade; Scores

Core tip: In this study, we validated the modified version of the albumin-bilirubin-TNM grade (mALBI-T) in a retrospective Egyptian cohort. In addition, this study offered a comparative analysis of eight different established and novel scoring systems. We concluded that the modified ALBI-T score is superior to the other scoring systems and offers a better prognostic tool.