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The ALBI Grade is a Good Predictive Model for Very Late Recurrence in Patients with Hepatocellular Carcinoma Undergoing Primary Resection

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Abstract

Background

Hepatocellular carcinoma (HCC) patients still have risk for very late recurrence after curative resection. This study assesses prognostic factors in HCC patients with recurrence-free survival (RFS) for 5 years after primary resection.

Methods

We enrolled 383 HCC patients who received primary tumor resection and achieved more than 5 years without recurrence after resection between January 2001 and April 2013. Predictive factors, including albumin-bilirubin (ALBI) grade, for RFS and overall survival (OS) were analyzed.

Results

After a median follow-up of 103 months, 57 patients (14.9%) had recurrent HCC, and 14 (3.7%) died. Independent predictors for HCC recurrence were male sex (p = 0.035), pre-operative liver cirrhosis (LC) (p = 0.025), serum creatinine  > 1.5 mg/dL (p = 0.045), post-operative 5th-year alpha-fetoprotein (AFP) > 15 ng/ml (p < 0.001), LC (p = 0.004), and ALBI grades 2 and 3 (p < 0.001). I ndependent risk factors for poor survival were age >70 years (p = 0.002), post-operative 5th-year AFP > 15 ng/ml (p = 0.003), and ALBI grades 2 and 3 (p = 0.002). Patients whose deteriorated ALBI grades 5 years after resection had adverse RFS outcomes compared to those with constant (p = 0.056) and improved ALBI grades (p = 0.008). In subgroup analysis, patients with post-operative 5th-year ALBI grades 2 and 3 had significantly poorer RFS and OS (both p < 0.001) than those with grade 1 among patients with low post-operative 5th-year AFP (<15 ng/mL).

Conclusion

In HCC patients without recurrence for 5 years after curative resection, post-operative 5th-year ALBI grade is useful for predicting outcomes, even with low AFP during follow-up.

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Abbreviations

ALBI:

Albumin-bilirubin

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Acknowledgements

This study was supported by Grants CMRPG8F0661 and CMRPG890161 from Chang Gung Memorial Hospital, Taiwan. The authors would like to thank all of the patients and their providers who participated in this study. Furthermore, we thank Chih-Yun Lin and the Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital for the statistical work.

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Authors and Affiliations

  1. Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, 123 Ta Pei Road, Kaohsiung, Taiwan

    Chun-Yu Lin, Tsung-Hui Hu, Chao-Hung Hung, Pao-Yuan Huang & Ming-Chao Tsai

  2. Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Chih-Che Lin, Chih-Chi Wang & Chao-Long Chen

  3. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Ming-Chao Tsai

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  1. Chun-Yu Lin
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Contributions

Dr. M-CT designed the study, and Dr. C-YL contributed to the writing of the manuscript. The other authors were actively involved in the interpretation of the results, provided critical review of the manuscript, and contributed to the final decision about the article’s content.

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Correspondence to Ming-Chao Tsai.

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Lin, CY., Lin, CC., Wang, CC. et al. The ALBI Grade is a Good Predictive Model for Very Late Recurrence in Patients with Hepatocellular Carcinoma Undergoing Primary Resection. World J Surg 44, 247–257 (2020). https://doi.org/10.1007/s00268-019-05197-3

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  • DOI: https://doi.org/10.1007/s00268-019-05197-3

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