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Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis

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Abstract

Purpose

Hepatic function is a key prognostic marker in patients with hepatocellular cancer (HCC) and central to patient selection for transarterial chemoembolization (TACE). We investigated the clinical utility of the Albumin-Bilirubin (ALBI) grade, an emerging prognostic model, in this heterogenous cohort via a meta-analysis of published studies.

Methods

Publications including full text articles and abstracts regarding ALBI grade were sourced by two independent researchers from databases including PubMed, Embase, Medline and Cochrane Library. Studies analysing patients with HCC undergoing TACE treatment were systematically screened utilising the PRISMA tool for data extraction and synthesis, after exclusion of duplicates, irrelevant studies and overlapping cohorts. The primary outcome was overall survival (OS), as determined by ALBI grade and assessed by hazard ratio (HRs) with 95% confidence intervals (CIs), with analysis of collated data using comprehensive meta-analysis, version 3.0 software.

Results

Eight studies were included, with a pooled population of 6538 patients with HCC that underwent TACE treatment. Higher pre-treatment grade was associated with poor OS, with median OS of 12.0 months (P < 0.001) in ALBI grade 3, compared to 33.5 months in ALBI grade 1 (P < 0.001). Significant heterogeneity within each ALBI grade was associated with age and tumour size (P < 0.001) in ALBI grades 1 and 2. In contrast, age and alcohol–related liver disease were significant in the ALBI grade 3 group (P < 0.001).

Conclusions

High pre-treatment ALBI grade is associated with poorer prognosis in patients with HCC undergoing TACE therapy. The ALBI grade demonstrates clinical utility for clinical prognostication and patient selection for TACE.

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Authors and Affiliations

  1. Gastroenterology Department, Monash Medical Centre, Melbourne, Australia

    Gauri Mishra & Anouk Dev

  2. School of Clinical Sciences, Monash University, Melbourne, Australia

    Gauri Mishra, Ammar Majeed, Anouk Dev & Stuart K. Roberts

  3. Gastroenterology Department, Alfred Health, Melbourne, Australia

    Ammar Majeed & Stuart K. Roberts

  4. The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Sydney, Australia

    Guy D. Eslick

  5. Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK

    David J. Pinato

  6. Gastroenterology Centre, Ehime Prefectural Central Hospital, Matsuyama, Japan

    Atsushi Hiraoka

  7. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan

    Teh-Ia Huo

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

    Teh-Ia Huo

  9. Internal Medicine, University of Texas Southwestern Medical Centre, Dallas, Texas, USA

    Po-Hong Liu

  10. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK

    Philip J. Johnson

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Contributions

GM, AM and SKR contributed to the study design; GM and AM performed systematic review; GDE performed statistical analysis; DJP, HI, AH, TH, PL and PJ provided significant data input; all authors contributed to the drafting and/or review of the manuscript.

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Correspondence to Gauri Mishra.

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As a systematic review and meta-analysis, this study did not require approval by the Institutional Review Board or ethics committee.

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Supplementary Information

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12029_2022_832_MOESM1_ESM.pdf

Supplementary file1: Factors associated with heterogeneity in patients in each ALBI grade; ALBI grade 1 (A-C), ALBI grade 2 (D-E), ALBI grade 3 (F, G) (PDF 125 KB)

12029_2022_832_MOESM2_ESM.jpg

Supplementary file2: Funnel plot of publications included for analysis in each ALBI grade; ALBI grade 1 (A), ALBI grade 2 (B), ALBI grade 3 (C) (JPG 455 KB)

12029_2022_832_MOESM3_ESM.jpg

Supplementary file3: Forest plots evaluating effect of geographical variations in ALBI grade 1 (A), grade 2 (B), and grade 3 (C) on overall survival (JPG 1083 KB)

12029_2022_832_MOESM4_ESM.xlsx

Supplementary file4: Harrell’s C index and AIC by ALBI grade, Child Pugh grade, BCLC stage, MELD and further sub stratification of Child Pugh grade and BCLC stage by ALBI grade, for each included study (XLSX 32 KB)

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Mishra, G., Majeed, A., Dev, A. et al. Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis. J Gastrointest Canc 54, 420–432 (2023). https://doi.org/10.1007/s12029-022-00832-0

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