Scientific publications

Long-term impact of liver function on curative therapy for hepatocellular carcinoma: application of the ALBI grade

Mar 29, 2016 | Magazine: British Journal of Cancer

Toyoda H (1), Lai PB (2), O'Beirne J (3), Chong CC (2), Berhane S (4), Reeves H (5,6), Manas D (6), Fox RP (7), Yeo W (8), Mo F (8), Chan AW (9), Tada T (1), Iñarrairaegui M (10), Vogel A (11), Schweitzer N (11), Chan SL (8), Sangro B (10), Kumada T (1), Johnson PJ (4,12)
(1) Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
(2) Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
(3) The Sheila Sherlock Liver Centre, Royal Free Hospital, London NW3 2QG, UK.
(4) Department of Molecular and Clinical Cancer Medicine, The Duncan Building, Daulby Street, University of Liverpool, Liverpool L69 3GA, UK.
(5) Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
(6) The Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Freeman Road, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK.
(7) Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK.
(8) State Key Laboratory in Oncology in South China, Sir YK Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
(9) Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
(10) Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
(11) Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Straβe 1, 30625 Hannover, Germany.
(12) The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK. 


Application of curative therapy for hepatocellular carcinoma is crucially dependent on underlying liver function. Using the recently described ALBI grade we examined the long-term impact of liver dysfunction on survival of early-stage hepatocellular carcinoma (HCC) patients.


This cohort study comprised 2559 HCC patients from different geographic regions, all treated with curative intent. We also examined the relation between indocyanine green (ICG) clearance and ALBI score. Survival was measured from the date of treatment to the date of death or last follow-up.


The ALBI score correlated well with ICG clearance. Among those undergoing surgical resection, patients with ALBI grade-1 (good liver function) survived approximately twice as long as those with ALBI grade-2 (less good liver function), although more than 90% of these patients were classified as Child-Pugh (C-P) grade A. In the cohort receiving ablative therapies, there was a similar difference in survival between ALBI grade-1 and grade-2. Cox regression analysis confirmed that the ALBI score along with age, gender, aetiology and tumour factors (AFP, tumour size/number and vascular invasion) independently influenced survival in HCC patients receiving curative treatments.


The ALBI score represents a simple approach to the assessment of liver function in patients with HCC. After potentially curative therapy, those with ALBI grade-1 survived approximately twice as long as those with ALBI grade-2. These data suggest that ALBI grade-1 patients are appropriately treated with surgical resection whereas ALBI grade-2 patients may, where the option exists, be more suitable for liver transplantation or the less invasive curative ablative therapies.

CITATION  Br J Cancer. 2016 Mar 29;114(7):744-750. doi: 10.1038/bjc.2016.33

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