Liver Cancer (Oct 2020)

EZ-ALBI Score for Predicting Hepatocellular Carcinoma Prognosis

  • Kazuya Kariyama,
  • Kazuhiro Nouso,
  • Atsushi Hiraoka,
  • Akiko Wakuta,
  • Ayano Oonishi,
  • Teiji Kuzuya,
  • Hidenori Toyoda,
  • Toshifumi Tada,
  • Kunihiko Tsuji,
  • Ei Itobayashi,
  • Toru Ishikawa,
  • Koichi Takaguchi,
  • Akemi Tsutsui,
  • Noritomo Shimada,
  • Masatoshi Kudo,
  • Takashi Kumada

DOI
https://doi.org/10.1159/000508971
Journal volume & issue
Vol. 9, no. 6
pp. 734 – 743

Abstract

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Introduction: The ALBI score is acknowledged as the gold standard for the assessment of liver function in patients with hepatocellular carcinoma (HCC). Unlike the Child-Pugh score, the ALBI score uses only objective parameters, albumin (Alb) and total bilirubin (T.Bil), enabling a better evaluation. However, the complex calculation of the ALBI score limits its applicability. Therefore, we developed a simplified ALBI score, based on data from a large-scale HCC database.We used the data of 5,249 naïve HCC cases registered in eight collaborating hospitals. Methods: We developed a new score, the EZ (Easy)-ALBI score, based on regression coefficients of Alb and T.Bil for survival risk in a multivariate Cox proportional hazard model. We also developed the EZ-ALBI grade and EZ-ALBI-T grade as alternative options for the ALBI grade and ALBI-T grade and evaluated their stratifying ability. Results: The equation used to calculate the EZ-ALBI score was simple {[T.Bil (mg/dL)] – [9 × Alb (g/dL)]}; this value highly correlated with the ALBI score (correlation coefficient, 0.981; p < 0.0001). The correlation was preserved across different Barcelona clinic liver cancer grade scores (regression coefficient, 0.93–0.98) and across different hospitals (regression coefficient, 0.98–0.99), indicating good generalizability. Although a good agreement was observed between ALBI and EZ-ALBI, discrepancies were observed in patients with poor liver function (T.Bil, ≥3 mg/dL; regression coefficient, 0.877). The stratifying ability of EZ-ALBI grade and EZ-ALBI-T grade were good and their Akaike’s information criterion values (35,897 and 34,812, respectively) were comparable with those of ALBI grade and ALBI-T grade (35,914 and 34,816, respectively). Conclusions: The EZ-ALBI score, EZ-ALBI grade, and EZ-ALBI-T grade are useful, simple scores, which might replace the conventional ALBI score in the future.

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