The Predictive Effect Of ALBI Grading On Overall Survival Of HCC Patients With Surgical Resection

Objective:The data of hepatocellular carcinoma（HCC）patients under surgical resection in our hospital were retrospectively analyzed to investigate the predictive effect of Albumin-Bilirubin grade（ALBI grade）on overall survival（OS）,the risk factors affecting patients’OS,and the correlation between ALBI score and indocyanine green retention rate at 15 minutes（ICG-R15）.The whole study hopes to clarify the importance and clinical significance of ALBI grade,provide native evidence for the utility of ALBI grade in Chinese HCC patients.Methods:The data of HCC patients under surgical resection from January 1,2014 to December 31,2019 in our hospital were collected.Patients only with initial radical surgical resection and postoperative pathological confirmation of HCC were included in this analysis,except for liver cancer rupture and bleeding,HCC distant metastasis or malignant tumors in other sites,postoperative pathology confirmation of mixed HCC-intrahepatic cholangiocarcinoma（ICC）and patients without follow-up.The calculation of ALBI score and ALBI grade were according to the following formula and standard:ALBI score=0.66×log₁₀（bilirubinμmol/L）-0.085×（albumin g/L）;ALBI score≤-2.60 is ALBI grade 1,ALBI score from-2.60 to-1.39 is ALBI grade 2 and ALBI score>-1.39 is ALBI grade 3.Statistical analysis was performed in SPSS25.0.The quantitative data were described as mean±standard deviation,while the qualitative data were described as percentage.The Kaplan-Meier method was used to calculate the survival rate between each group and plot the survival curve,then the log-rank test was used to compare the survival rate between each group.Univariate and multivariate COX regression analysis was performed to identify risk factors affecting OS.The correlation between the preoperative ALBI score and ICG-R15 was analyzed using linear regression.P<0.05 is considered statistically significant.Results:A total of 104 patients were enrolled in this study.According to the postoperative ALBI classification,there were no postoperative ALBI grade 1 patients,93 postoperative ALBI grade 2 patients,and 11postoperative ALBI grade 3 patients.There were differences in Kaplan-Meier survival curve of postoperative ALBI grade 3 and grade 2.The p value of log-rank test is less than 0.001.Univariate and multivariate COX regression analysis for OS showed that the p value of surgical resection ranges（≥3 Couinaud segments vs<3 Couinaud segments）,surgery related complications（happened vs not happened）and postoperative ALBI grade（grade 3 vs grade 2）is<0.05,with statistical significane.The hazard ratio（HR）and 95%confidence interval（95%CI）were 4.74（2.32-9.67）,2.95（1.38-6.31）and 2.50（1.18-5.31）,respectively.The p value of linear regression analysis between preoperative ALBI score and ICG-R15（%）is 0.001,less than 0.05.So,there is linear relationship between the two indexes and the regression equation was[preoperative ALBI score]=-2.736+0.016×[ICG-R15（%）].Let ICG-R15（%）=30,according to the regression equation the cut-off value of ICG-R15<30%corresponding to the preoperative ALBI score was-2.256.Conclusions:Postoperative ALBI grade can be used as an index for predicting the OS of HCC patients after surgical resection.The OS of postoperative ALBI grade 3 patients is shorter than postoperative ALBI grade 2 patients.The surgical resection ranges≥3 Couinaud segments,postoperative complications happened and postoperative ALBI grade 3 were risk factors for the OS.There was a positive linear relationship between preoperative ALBI score and ICG-R15（%）and they are complementary.