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A New Prognostic Model Based on Albumin–Bilirubin Grade for Hepatocellular Carcinoma Beyond the Milan Criteria

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Abstract

Background

The survival of patients with advanced hepatocellular carcinoma (HCC) is highly variable due to heterogeneous tumoral characteristics. We proposed and validated an albumin–bilirubin (ALBI)-based model for HCC beyond Milan criteria, the ALBI-HOME, for these patients.

Methods

A total of 2186 patients were enrolled and randomly assigned to the derivation cohort (n = 1093) and validation cohort (n = 1093). Multivariate Cox proportional hazards model was used to determine significant prognostic factors in the derivation cohort. The performance of ALBI-HOME was evaluated in the validation cohort.

Results

In the Cox model, six factors were identified as independent predictors of poor survival: ALBI grade 2 [hazard ratio (HR) 1.848, 95% confidence incidence (CI) 1.556–2.195, p < 0.001], ALBI grade 3 (HR 3.266, 95% CI 2.531–4.215, p < 0.001), serum AFP ≥ 100 ng/ml (HR 1.482, 95% CI 1.279–1.717, p < 0.001), total tumor volume ≥ 250 cm3 (HR 1.503, 95% CI 1.294–1.746, p < 0.001), ascites (HR 1.400, 95% CI 1.187–1.561, p < 0.001), performance status 0–1 (HR 1.756, 95% CI 1.485–2.076 p < 0.001), and vascular invasion or metastasis (HR 2.110, 95% CI 1.809–2.0, p < 0.001). The ALBI-HOME is based on these six parameters, and the score ranges from 0 to 7. This model was associated with the best prognostic ability among different HCC staging systems to predict survival in patients beyond Milan criteria; its ability remained consistently stable in different treatment subgroups and viral etiologies.

Conclusions

The proposed ALBI-HOME is a simple and feasible predictive model for HCC beyond Milan criteria. It demonstrates superior prognostic performance among the currently used staging systems and may help identify at-risk patients to undergo more aggressive treatments.

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Acknowledgments

This study was supported by the grants from Taipei Veterans General Hospital (V107A-008, VN107-04, V108A-002, V108C-008, VN108-05), Taipei, Taiwan.

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Authors and Affiliations

  1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Shu-Yein Ho, Yi-Hsiang Huang, Chien-Wei Su, Ming-Chih Hou & Teh-Ia Huo

  2. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

    Cheng-Yuan Hsia & Hao-Jan Lei

  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Rheun-Chuan Lee

  4. Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei, 11217, Taiwan

    Teh-Ia Huo

  5. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Shu-Yein Ho, Po-Hong Liu, Chia-Yang Hsu, Cheng-Yuan Hsia, Yi-Hsiang Huang, Chien-Wei Su, Hao-Jan Lei, Rheun-Chuan Lee & Ming-Chih Hou

  6. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Yi-Hsiang Huang

  7. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan

    Teh-Ia Huo

  8. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Po-Hong Liu

  9. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA

    Chia-Yang Hsu

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  1. Shu-Yein Ho
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Contributions

S.-Y. Ho and T.-I. Huo performed the research and wrote the paper. C.-Y. Hsu, P.-H. Liu, C.-Y. Hsia, and C.-W. Su collected and analyzed the data. H.-J. Lei, Y.-H. Huang, R.-C. Lee, and M.-C. Hou contributed to study design and data collection. All authors approved the final version of the manuscript.

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Correspondence to Teh-Ia Huo.

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Ho, SY., Liu, PH., Hsu, CY. et al. A New Prognostic Model Based on Albumin–Bilirubin Grade for Hepatocellular Carcinoma Beyond the Milan Criteria. Dig Dis Sci 65, 658–667 (2020). https://doi.org/10.1007/s10620-019-05813-1

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