Preoperative albumin-bilirubin score predicts short-term outcomes and long-term prognosis in colorectal cancer patients undergoing radical surgery

doi:10.4240/wjgs.v16.i7.2096

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jul 27, 2024; 16(7): 2096-2105
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2096

Table 1 Baseline information of high albumin-bilirubin group and low albumin-bilirubin group, n (%)

Characteristic	Low ALBI (1908)	High ALBI (2117)	P value
Age, years	60.0 ± 11.6	65.4 ± 12.1	< 0.01^a
Sex			0.096
Male	1098 (57.5)	1273 (60.1)
Female	801 (42.5)	844 (44.2)
BMI, kg/m²	23.1 ± 3.1	22.4 ± 3.3	< 0.01^a
Smoking	707 (37.1)	813 (38.4)	0.378
Drinking	580 (30.4)	650 (30.7)	0.834
Hypertension	475 (24.9)	575 (27.2)	0.102
T2DM	225 (11.8)	273 (12.9)	0.289
CHD	55 (2.9)	117 (5.5)	< 0.01^a
Albumin, g/L	44.3 ± 3.8	36.3 ± 4.1	< 0.01^a
Total bilirubin, μmol/L	10.9 ± 5.4	12.0 ± 6.3	< 0.01^a
ALBI	-3.1 ± 0.3	-2.4 ± 0.3	< 0.01^a
Surgical history	446 (23.4)	500 (23.6)	0.856
Open surgery	163 (8.5)	365 (17.2)	< 0.01^a
Tumor location			< 0.01^a
Colon	1132 (59.3)	1005 (47.5)
Rectum	776 (40.7)	1112 (52.5)
TNM stage			< 0.01^a
I	449 (23.5)	348 (16.4)
II	770 (40.4)	956 (45.2)
III	689 (36.1)	813 (38.4)
Tumor size			< 0.01^a
< 5 cm	1241 (65.0)	1106 (52.2)
≥ 5 cm	667 (35.0)	1011 (47.8)

^aP < 0.05.

ALBI: Albumin-bilirubin; T2DM: Type 2 diabetes mellitus; BMI: Body mass index; CHD: Coronary heart disease.

Table 2 Short-term outcomes in high albumin-bilirubin group and low albumin-bilirubin group

Characteristic	Low ALBI (1908)	High ALBI (2117)	P value
Operation time (min)	223.6 ± 79.6	226.3 ± 81.7	0.295
Intraoperative blood loss (mL)	90.5 ± 122.5	104.4 ± 139.4	0.001^a
Blood transfusion (%)	25 (1.3)	51 (2.4)	0.011
Postoperative hospital stay (d)	10.7 ± 9.4	11.6 ± 8.0	0.001^a
Overall complications (%)	323 (16.9)	557 (26.3)	< 0.01^a
Major complications (%)	32 (1.7)	61 (2.9)	< 0.01^a

^aP < 0.05.

ALBI: Albumin-bilirubin.

Table 3 Univariate and multivariate analysis of overall survival

Risk factor	Univariate analysis		Multivariate analysis
Risk factor	HR (95%CI)	P value	HR (95%CI)	P value
Age (years)	1.045 (1.037-1.053)	< 0.01^a	1.038 (1.030-1.046)	< 0.01^a
Sex (male/female)	0.873 (0.733-1.040)	0.128
BMI (kg/m²)	0.952 (0.926-0.978)	< 0.01^a	0.984 (0.958-1.012)	0.263
T2DM (yes/no)	1.280 (1.002-1.633)	0.048^a	0.981 (0.765-1.259)	0.883
Tumor site (colon/rectum)	1.173 (0.989-1.390)	0.066
Tumor stage (III/II/I)	2.133 (1.864-2.440)	< 0.01^a	2.099 (1.830-2.407)	< 0.01^a
Smoking (yes/no)	1.055 (0.887-1.256)	0.543
Drinking (yes/no)	1.025 (0.852-1.232)	0.796
Hypertension (yes/no)	1.016 (0.836-1.234)	0.874
Tumor size (≥ 5 cm/< 5 cm)	1.464 (1.235-1.736)	< 0.01^a	1.231 (1.037-1.461)	0.017^a
ALBI (high/low)	1.900 (1.587-2.274)	< 0.01^a	1.368 (1.134-1.649)	0.001^a
Overall complications (yes/no)	1.886 (1.580-2.252)	< 0.01^a	1.619 (1.353-1.938)	< 0.01^a

^aP < 0.05.

BMI: Body mass index; T2DM: Type 2 diabetes mellitus, ALBI: Albumin-bilirubin.

Table 4 Univariate and multivariate analysis of disease-free survival

Risk factor	Univariate analysis		Multivariate analysis
Risk factor	HR (95%CI)	P value	HR (95%CI)	P value
Age (years)	1.033 (1.026-1.040)	<0.01^a	1.027 (1.020-1.035)	< 0.01^a
Sex (male/female)	0.885 (0.757-1.035)	0.127
BMI (kg/m²)	0.972 (0.949-0.996)	0.023^a	0.997 (0.973-1.021)	0.777
T2DM (yes/no)	1.129 (0.899-1.418)	0.297
Tumor site (colon/ rectum)	1.095 (0.940-1.276)	0.245
Tumor stage (III/II/I)	2.046 (1.816-2.305)	< 0.01^a	2.020 (1.790-2.280)	< 0.01^a
Smoking (yes/no)	1.037 (0.918-1.255)	0.374
Drinking (yes/no)	1.029 (0.872-1.214)	0.736
Hypertension (yes/no)	1.027 (0.863-1.223)	0.763
Tumor size (≥ 5 cm/< 5 cm)	1.320 (1.133-1.538)	< 0.01^a	1.134 (0.972-1.323)	0.110
ALBI (high/low)	1.585 (1.354-1.855)	< 0.01^a	1.504 (1.276-1.774)	< 0.01^a
Overall complications (yes/no)	1.686 (1.433-1.983)	< 0.01^a	1.241 (1.053-1.463)	0.010^a

^aP < 0.05.

BMI: Body mass index; T2DM: Type 2 diabetes mellitus, ALBI: Albumin-bilirubin.

Table 5 Previous studies reporting the albumin-bilirubin score of colorectal cancer patients

Ref.	Year	Country	Sample size	High ALBI, n (%)	Patients	Outcomes
Zhu et al[26]	2020	China	284	165 (58.1)	CRC	ALBI score was an independent indicator for postoperative complications and OS after radical surgery
Koh et al[27]	2022	South Korea	1015	173 (17.0)	CRC	ALBI score was an independent risk factor for OS in patients after radical CRC patients
Abdel-Rahman[28]	2019	Canada	1434	648 (45.2)	mCRC	ALBI score was an independent risk factor for OS and progression-free survival in CRC patients with liver metastasis after chemotherapy
Watanabe et al[29]	2021	Japan	60	28 (46.7)	CRC	High-ALBI group had shorter OS, and was correlated with shorter time to treatment failure and liver dysfunction in CRC patients treated with regorafenib

CRC: Colorectal cancer; mCRC: Metastatic colorectal cancer; ALBI: Albumin-bilirubin; OS: Overall survival.

Citation: Diao YH, Shu XP, Tan C, Wang LJ, Cheng Y. Preoperative albumin-bilirubin score predicts short-term outcomes and long-term prognosis in colorectal cancer patients undergoing radical surgery. World J Gastrointest Surg 2024; 16(7): 2096-2105
URL: https://www.wjgnet.com/1948-9366/full/v16/i7/2096.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i7.2096