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The role of preoperative albumin‐bilirubin grade for oncological risk stratification in liver transplant patients with hepatocellular carcinoma
Author(s) -
Kornberg Arno,
Witt Ulrike,
Schernhammer Martina,
Kornberg Jennifer,
Müller Katharina,
Friess Helmut,
Thrum Katharina
Publication year - 2019
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25721
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , milan criteria , hazard ratio , odds ratio , confidence interval , liver transplantation , hepatectomy , bilirubin , liver function , risk stratification , oncology , surgery , transplantation , resection
Background and Objectives Albumin‐bilirubin (ALBI) score was shown to correlate with liver function and tumor recurrence after hepatectomy for hepatocellular carcinoma (HCC). The aim of this study was to assess the prognostic value of ALBI grade in liver transplantation (LT) patients with HCC. Methods Pre‐LT available independent predictors of recurrence‐free survival (RFS) and microvascular tumor invasion (MVI) were determined in 123 patients with HCC. Results Posttransplant HCC recurrence rates were 10.5%, 15.9%, and 68.2% in ALBI grade 1, 2, and 3, respectively ( P < .001). Along with serum α‐fetoprotein (AFP) and C‐reactive protein (CRP) levels, ALBI grades 1 or 2 was identified as an independent predictor of RFS (hazard ratio, 3.52; 95% confidence interval [CI], 1.577‐7.842; P = .002). Furthermore, ALBI grade 3 proved to be the strongest indicator of MVI (odds ratio, 11.59; 95% CI, 3.412‐39.381; P < .001). A novel oncological risk score‐based on AFP, CRP, and ALBI grade provided the best discriminative capacity (c‐statistic 0.806) in selecting liver recipients with low oncological risk profile. Conclusion Preoperative ALBI grade seems to be valuable for refinement of oncological risk stratification at LT for HCC.