Validation of Modified ALBI Grade for More Detailed Assessment of Hepatic Function in Hepatocellular Carcinoma Patients: A Multicenter Analysis

Atsushi Hiraoka, Takashi Kumada, Kunihiko Tsuji, Koichi Takaguchi, Ei Itobayashi, Kazuya Kariyama, Hironori Ochi, Kazuto Tajiri, Masashi Hirooka, Noritomo Shimada, Toru Ishikawa, Yoshihiko Tachi, Toshifumi Tada, Hidenori Toyoda, Kazuhiro Nouso, Kouji Joko, Yoichi Hiasa, Kojiro Michitaka, Masatoshi Kudo

Research output: Contribution to journalArticlepeer-review

91 Citations (Scopus)


Background/Aim: The frequency of hepatocellular carcinoma (HCC) in patients with good hepatic reserve function has been increasing in Japan along with the progression of antiviral therapies and aging of the society. We evaluated the usefulness of modified albumin-bilirubin (ALBI) grade as a tool for assessment of hepatic reserve function. Materials/Methods: We enrolled 6,649 naïve HCC patients treated from 2000 to 2017 and divided them into training (Ehime Prefecture group: E group, n = 2,357) and validation (validation group: V group, n = 4,292) cohorts. Child-Pugh classification and ALBI and modified ALBI (mALBI) grading were compared using with Japan Integrated Staging (JIS), ALBI-TNM (ALBI-T), and mALBI-T scores, which were calculated based on TNM stage and each assessment tool, retrospectively. Results: In the E group, Akaike's Information Criterion (AIC) and c-index values for mALBI-T (13,725.2/0.744) were better as compared to those of ALBI-T (13,772.6/0.733) and JIS score (13,874.7/0.720), with similar results observed in the V group (mALBI-T: 27,727.4/0.760; ALBI-T: 27,817.8/0.750; JIS: 27,807.5/0.748). Although there were some significant differences between the groups with regard to clinical background factors (age, etiology, tumor size, tumor number, treatment modalities), for all patients the AIC and c-index values of mALBI-T (45,327.1/0.755) were also better than those of ALBI-T (45,467.7/0.744) and JIS scores (45,555.8/0.739), indicating its superior stratification ability and prognostic predictive value in patients with HCC. Conclusion: The detailed stratification ability of mALBI grade for hepatic reserve function is suitable for the recent trend of HCC patients, while mALBI-T may provide a more accurate predictive value than existing total staging scoring systems.

Original languageEnglish
Pages (from-to)121-129
Number of pages9
JournalLiver Cancer
Issue number2
Publication statusPublished - 01-03-2019
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Oncology


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