Modified Albumin-Bilirubin Grade After Curative Treatment: Predicting the Risk of Late Intrahepatic Recurrence of Hepatocellular Carcinoma

• Published in: Journal of Korean medical science Vol. 39; no. 37; pp. e251 - 13
• Main Authors: Goh, Myung Ji, Park, Hee Chul, Kim, Nalee, Bae, Bong Kyung, Choi, Moon Seok, Rhu, Jinsoo, Lee, Min Woo, Jeong, Woo Kyoung, Kim, Minji, Kim, Kyunga, Yu, Jeong Il
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 30.09.2024; 대한의학회
• Subjects: Adult; Aged; Bilirubin - blood; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Disease-Free Survival; Female; Hepatectomy; Humans; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Male; Middle Aged; Neoplasm Recurrence, Local - pathology; Original; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Serum Albumin - analysis; Serum Albumin - metabolism; 의학일반; Curative Treatment; Recurrence; Prognosis; Liver Function; Albumin-Bilirubin Grade; Hepatocellular Carcinoma
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2024.39.e251

We aimed to identify the prognostic factors for late intrahepatic recurrence (IHR), defined as recurrence more than two years after curative treatment of newly diagnosed hepatocellular carcinoma (HCC). This retrospective cohort study included patients with newly diagnosed, previously untreated, very early, or early HCC treated with initial curative treatment and followed up without recurrence for more than two years, excluding early IHR defined as recurrence within two years in single center. Late IHR-free survival (IHRFS) was defined as the time interval from initial curative treatment to the first IHR or death without IHR, whichever occurred first. Among all the enrolled 2,304 patients, 1,427 (61.9%) underwent curative intent hepatectomy and the remaining 877 (38.1%) underwent local ablative therapy (LAT). During the follow-up after curative treatment (median, 82.6 months; range, 24.1 to 195.7), late IHR was detected in 816 (35.4%) patients. In the multivariable analysis, age, male sex, cirrhotic liver at diagnosis, type of initial treatment, and modified albumin-bilirubin (mALBI) grade were significant prognostic baseline factors. Furthermore, mALBI grade at three (2a vs. 1, = 0.02, hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04-1.70; 2b/3 vs. 1, = 0.03; HR, 1.42; 95% CI, 1.03-1.94) and six months (2b/3 vs. 1; = 0.006; HR, 1.61; 95% CI, 1.13-2.30) after initial curative treatment was also a significant prognostic factor for late IHR. After curative treatment for newly diagnosed early HCC, the mALBI grade at three and six months after initial curative treatment, as well as at baseline, was one of the most crucial prognostic factors for late IHR.