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Albumin-Bilirubin Grade and Tumor Burden Score Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma After Hepatic Resection: a Multi-Institutional Analysis

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

The prognostic role of tumor burden score (TBS) relative to albumin-bilirubin (ALBI) grade among patients undergoing curative-intent resection of ICC has not been examined.

Methods

We identified patients who underwent curative-intent resection for ICC between 1990 and 2017 from a multi-institutional database. Multivariable analysis was performed to assess the effect of TBS relative to ALBI grade on both short- and long-term outcomes.

Results

Among 724 patients, 360 (49.7%) patients had low TBS and low ALBI grade, 142 (19.6%) patients had low TBS and high ALBI grade, 138 (19.1%) patients had high TBS and low ALBI grade, and 84 patients (11.6%) had high TBS and high ALBI grade. Decreased tumor burden was associated with better long-term outcomes among patients with both low (5-year OS; low TBS vs. high TBS: 52.4% vs 21.4%; p < 0.001) and high ALBI grade (5-year OS; low TBS vs. high TBS: 40.7% vs 12.0%; p < 0.001). On multivariable analysis, higher ALBI grade was associated with greater odds of an extended hospital LOS (> 10 days) (OR 2.80, 95%CI 1.62–4.82; p < 0.001), perioperative transfusion (OR 2.04, 95%CI 1.25–3.36; p = 0.005), 90-day mortality (OR 2.56, 95%CI 1.12–5.81; p = 0.025), as well as a major complication (OR 1.99, 95%CI 1.13–3.49; p = 0.016) among patients with similar tumor burden. Of note, patients with high TBS and high ALBI grade had markedly worse overall survival compared with patients who had low TBS and low ALBI grade disease (HR 2.27; 95%CI 1.44–3.59; p < 0.001). Importantly, high TBS and high ALBI grade were strongly associated with both early recurrence (88.1%%) and 5-year risk of death (96.4%).

Conclusion

Both TBS (i.e., tumor morphology) and ALBI grade (i.e., hepatic function reserve) were strong predictors of outcomes among patients undergoing ICC resection. There was an interplay between TBS and ALBI grade relative to patient prognosis after hepatic resection of ICC with high ALBI grade predicting worse outcomes among ICC patients with different TBS.

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Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Author information

Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Muhammad Musaab Munir, Yutaka Endo, Henrique A. Lima, Laura Alaimo, Zorays Moazzam, Chanza Shaikh & Timothy M. Pawlik

  2. Department of Surgery, Stanford University, Stanford, CA, USA

    George A. Poultsides

  3. Department of Surgery, University of Verona, Verona, Italy

    Alfredo Guglielmi

  4. Department of Surgery, Ospedale San Raffaele, Milan, Italy

    Luca Aldrighetti

  5. Department of Surgery, John Hopkins Hospital, Baltimore, MA, USA

    Matthew Weiss

  6. Department of Surgery, University of Virginia, Charlottesville, VA, USA

    Todd W. Bauer

  7. Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania

    Sorin Alexandrescu

  8. Department of Surgery, Keio University, Tokyo, Japan

    Minoru Kitago

  9. Department of Surgery, Emory University, Atlanta, GA, USA

    Shishir K. Maithel

  10. Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal

    Hugo P. Marques

  11. Department of Surgery, University of Ottawa, Ottawa, ON, Canada

    Guillaume Martel

  12. Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia

    Carlo Pulitano

  13. Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China

    Feng Shen

  14. Department of Hepatibiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France

    François Cauchy

  15. Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands

    Bas Groot Koerkamp

  16. Department of Gastroenterological Surgery, Yokohama City, University School of Medicine, Yokohama, Japan

    Itaru Endo

  17. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Columbus, OH, USA

    Timothy M. Pawlik

  18. Health Services Management and Policy, The Ohio State University, Wexner Medical Center, 395 W. 12Th Ave., Suite 670, Columbus, OH, USA

    Timothy M. Pawlik

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  1. Muhammad Musaab Munir
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Correspondence to Timothy M. Pawlik.

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Munir, M.M., Endo, Y., Lima, H.A. et al. Albumin-Bilirubin Grade and Tumor Burden Score Predict Outcomes Among Patients with Intrahepatic Cholangiocarcinoma After Hepatic Resection: a Multi-Institutional Analysis. J Gastrointest Surg 27, 544–554 (2023). https://doi.org/10.1007/s11605-023-05578-z

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