ALBI grade, tumor characteristics and survival of patients with hepatocellular carcinoma.

BACKGROUND: Albumin-Bilirubin (ALBI) grade has recently been introduced as an objective measure of liver function and has been shown to be useful in prognostication for patients with hepatocellular carcinoma (HCC). The reasons for this usefulness are not clear. AIMS: To determine, in HCC patients, whether ALBI grade correlates with indices of HCC aggressiveness. METHODS: A large cohort of non-surgical HCC patients was examined for ALBI grade in relation to maximum tumor diameter (MTD), tumor focality, percentage of patients with portal vein thrombosis (PVT), serum alpha-fetoprotein (AFP) levels and survival. RESULTS: ALBI grade was significantly associated with HCC aggressiveness parameters, particularly AFP, portal vein thrombosis (PVT) and tumor multifocality, but not with maximum tumor diameter (MTD). Similar associations were observed in the subset of patients with low AFP levels.ALBI grade showed a strong and graded relationship with survival, comparable to that observed for serum albumin alone. In Cox models stratified by ALBI categories, AFP, PVT, and tumor multifocality were independently associated with mortality. CONCLUSIONS: These findings suggest that ALBI reflects not only liver function, but also correlates with tumor aggressiveness features.