Preoperative ALBI grade predicts the outcomes in non-B non-C HCC patients undergoing primary curative resection

doi:10.21203/rs.3.rs-377346/v1

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Preoperative ALBI grade predicts the outcomes in non-B non-C HCC patients undergoing primary curative resection

https://doi.org/10.21203/rs.3.rs-377346/v1

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Background The albumin-bilirubin (ALBI) grade has been validated as a significant predictor for hepatocellular carcinoma (HCC). However, there is little information about the ALBI grade in patients with non-B non-C HCC (NBNC-HCC) receiving surgery. Aim This study aimed to evaluate ALBI grade as a prognostic factor in patients with NBNC-HCC after primary curative resection.

Method This retrospective study enrolled 2137 HCC patients, who received HCC resection between January 2001 and April 2016 at Kaohsiung Chang Gung Memorial Hospital. With exclusion criteria of patients who had chronic hepatitis B or chronic hepatitis C, and prior HCC treatment before resection and received liver transplantation and BCLC stage B or C, finally we enrolled 168 NBNC-HCC patients who received primary curative resection. ALBI score used for grading as well as clinic opathologic features was analyzed, the formula of ALBI score was log10 [albumin (mg/dL) x 17.1] x 0.66 – albumin (g/dL) x 0.85.

Result There were 66 (39.3%), 98 (58.3%), and 4 (2.4%) patients who were stratified into ALBI grade I, II, and III, respectively. Patients with ALBI grade II/III had older age (p = 0.002), hypoalbuminemia (p <0.001), and Child Pugh B (p = 0.009), they also had poor overall survival compared with those with ALBI grade I (p = 0.003). The patients without liver cirrhosis had better survival rate in ALBI grade 1 group (P = 4 0.012). In multivariate analysis, tumor number (p = 0.001) and tumor stages (pTNM stages) (p = 0.007) were independent prognostic factors for recurrence. In predictors for mortality, AFP (p = 0.004), ALBI grade (p = 0.004), tumor number (P=0.003) and tumor stages (pTNM stages) (p <0.001) were independent prognostic factors.

Conclusion Preoperative ALBI grade can be used to predict the mortality in patients with NBNC-HCC after primary curative resection.

Gastrointestinal Surgery

ALBI

NBNC

hepatocellular carcinoma

resection

recurrence

Table 1. Comparison of clinical and pathological characteristics between patients with pre-operative ALBI grades I and II

	Total (n=168)	ALBI grade I (n=66)	ALBI grade II/III (n = 102)^*	P value
Age (years; mean ± SD)	65.2 ± 12.2	58.9 ± 11.8	64.8 ± 12	0.002
Male, n (%)	131 (78%)	56 (84.8%)	75 (73.5%)	0.084
Diabetes mellitus, n (%)	58 (34.5%)	22 (33.3%)	36 (35.3%)	0.794
Hypertension, n (%)	90 (58.1%)	37 (60.7%)	53 (56.4%)	0.598
Current alcohol intake^$, n (%)	32 (24.2%)	16 (32.7%)	16 (19.3%)	0.083
AST (U/L; mean ± SD)	41.6 ± 74.4	34.7 ± 19.3	46.1 ± 94.1	0.333
ALT (U/L; mean ± SD)	44.1 ± 109.4	39.5 ± 23.3	47.2 ± 139.3	0.658
Total bilirubin (mg/dL; mean ± SD)	0.8 ± 0.3	0.8 ± 0.3	0.8 ± 0.4	0.132
Albumin (g/dL; mean ± SD)	3.7 ± 0.6	4.2 ± 0.3	3.4 ± 0.4	<0.001
Platelet (<150000 u/l), n (%)	38 (22.9%)	14 (21.5%)	24 (23.8%)	0.739
AFP (> 200ng/ml), n (%)	25 (15.3%)	11 (16.9%)	14 (14.3%)	0.647
Liver cirrhosis, n (%)	38 (22.6%)	13 (19.7%)	25 (24.5%)	0.466
Tumor size (cm; mean ± SD)	5.3 ± 3.7	4.5 ± 2.9	5.9 ± 4.1	0.09
Tumor number (single: multiple)	164 : 4	65 : 1	99 : 3	0.554
Child-Pugh grade (A : B)	158 : 10	66:0	92 : 10	0.009
BCLC stage (0 : A : B)	17 : 87 : 64	10 : 35 : 21	7 : 52 : 43	0.144
Pathological features
Fat content (%) in nontumor tissue, n (%) ^**				0.064
>30%	24 (17.5%)	15 (26.3%)	9 (11.3%)
5%-30%	37 (27.0%)	15 (26.3%)	22 (27.5%)
<5%	76 (55.5%)	27 (47.4%)	49 (61.3%)
Vascular invasion, n (%)	55 (35%)	19 (29.7%)	36 (38.7%)	0.224
pTNM stage (I : II : III)	101 : 58 : 8	41 : 23 : 1	60 : 3 5: 7	0.289
Histological grade (well : moderate: poor)	31 : 125 : 11	14 : 50 : 2	17 : 75 : 9	0.365

AST=Aspartate aminotransferase; ALT=Alanine aminotransferase; AFP = α-fetoprotein; BCLC=Barcelona Clinic Liver Cancer; ALBI = albumin-bilirubin

*4 cases are ALBI grade III

^$>80g ethanol per day

**137 cases had available data

Table 2. Univariate and multivariate analysis of prognostics factors for recurrence in NBNC-HCC patients after curative resection

		Univariate		Multivariate
Variable	Comparison	HR (95%CI)	P value	HR (95%CI)	P value
Age(years)	>60 vs ≦60	1.316 (0.815-2.125)	0.216
Sex	Male vs. Female	1.220 (0.698-2.131)	0.485
DM history	Yes vs. No	1.286 (0.800-2.068)	0.299
Hypertension	Yes vs. No	1.184 (0.694-2.020)	0.536
Alcoholic history	Yes vs. No	1.353 (0.748-2.446)	0.318
AFP (ng/ml)	>200 vs. ≦200	2.065 (1.149-3.710)	0.015	2.070 (1.114-3.848)	0.021
Platelet(/L)	≦150 vs. > 150	1.264 (0.754-2.119)	0.375
Albumin(g/dL)	≦3 vs. > 3	1.358 (0.833-2.215)	0.220
Liver cirrhosis	Yes vs. No	0.950 (0.552-1.635)	0.853
Child-Pugh grade	B vs. A	1.216 (0.682-2.168)	0.508
ALBI grade	II/III vs. I	1.052 (0.662-1.671)	0.831
Tumor size (cm)	>5 vs. ≦5	1.024 (0.634-1.653)	0.923
Tumor no.	Multiple vs. Single	2.847 (0.892-9.084)	0.077	10.770 (2.513-46.153)	0.001
BCLC stage	B vs. 0/A	1.004 (0.625-1.615)	0.985
Liver fat content (%)	>30 vs. ≦30	1.472 (0.811-2.673)	0.204
Vascular invasion	Yes vs. No	0.798 (0.479-1.329)	0.386
pTNM stages	II+III vs. I	2.084 (1.302-3.336)	0.002	1.962 (1.199-3.210)	0.007
Histology stages	Poor vs. well/moderate	1.699 (0.682-4.232)	0.255

DM=Diabetes mellitus; AST=Aspartate aminotransferase; ALBI = albumin-bilirubin

; BCLC=Barcelona Clinic Liver Cancer;

Table 3. Univariate and multivariate analysis of prognostics factors for overall survival in NBNC-HCC patients after curative resection

		Univariate		Multivariate
Variable	Comparison	HR (95%CI)	P value	HR (95%CI)	P value
Age(years)	>60 vs ≦60	2.117 (0.995-4.507)	0.052	2.939 (1.995-8.850)	0.005
Sex	Male vs. Female	0.983 (0.462-2.093)	0.965
DM	Yes vs. No	1.324 (0.670-2.617)	0.420
Hypertension	Yes vs. No	0.885 (0.364-2.152)	0.787
Alcoholic history	Yes vs. No	1.601 (0.630-4.064)	0.322
AFP (ng/ml)	>200 vs. ≦200	3.475 (1.648-7.329)	0.001	4.785 (1.943-11.783)	0.001
Platelet(/L)	≦150 vs. > 150	0.666 (0.276-1.605)	0.365
Albumin(g/dL)	≦3 vs. > 3	2.028 (0.872-4.716)	0.101
Liver cirrhosis	Yes vs. No	1.305 (0.629-2.706)	0.475
Child-Pugh grade	B vs. A	1.735 (0.526-5.723)	0.365
ALBI grade	II/III vs. I	3.126 (1.415-6.916)	0.005	3.689 (1.512-8.997)	0.004
Tumor size (cm)	>5 vs. ≦5	2.242 (1.163-4.321)	0.016
Tumor no.	Multiple vs. Single	3.705 (1.133-12.113)	0.03	9.993 (2.177-45.866)	0.003
BCLC stage	B vs. 0/A	2.323 (1.202-4.492)	0.012
Liver fat content (%)	>30 vs. ≦30	0.454 (0.105-1.965)	0.291
Vascular invasion	Yes vs. No	0.618 (0.290-1.317)	0.213
pTNM stages	III vs. I+II	6.395 (2.171-18.834)	0.001	8.853 (2.795-28.043)	<0.001
Histology stages	Poor vs. well/moderate	2.421 (0.732-8.001)	0.147

DM=Diabetes mellitus; AST=Aspartate aminotransferase; ALBI = albumin-bilirubin; BCLC=Barcelona Clinic Liver Cancer;

No competing interests reported.

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Editorial decision: Major revision
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Preoperative ALBI grade predicts the outcomes in non-B non-C HCC patients undergoing primary curative resection

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