Abstract
Hepatocellular carcinoma (HCC) is a leading cause of death worldwide. The selection of therapeutic modalities and the prognosis of affected patients are well known to be dependent not only on the tumor burden but also on the hepatic reserve function. Antiviral treatments for chronic hepatitis related to a viral infection and an increase in cases of nonviral HCC associated with the aging of society have resulted in dramatic changes regarding the characteristics of HCC patients. With recent developments in therapeutic modalities for HCC, a more detailed assessment of hepatic function has become an important need. Studies in which the relationship of albumin-bilirubin (ALBI) grade with the prognosis of HCC patients was investigated were reviewed in order to evaluate the usefulness of newly developed ALBI and modified ALBI (mALBI) grades for HCC treatment, as those scoring methods are considered helpful for predicting the prognosis and selecting therapeutic modalities based on the expected prognosis.
Highlights
Hepatocellular carcinoma (HCC) is a leading cause of death worldwide [1,2]
Khalid et al found that only the ALBI grade showed a statistically significant association with overall survival (OS) (HR 3.06, p = 0.038) [37], and Izumoto et al noted that ALBI grade 2 was a significant prognostic factor for worse OS in a study of 192 Barcelona Clinic liver cancer staging system (BCLC)-B HCC patients with good hepatic function
Not all u-HCC patients treated with sorafenib meet the RESORCE trial criteria [51] at the time of sorafenib failure, and the frequency of those indicated for regorafenib has been reported to range from only 30.6% to 44.2% after confirmation by radiological findings to have PD with sorafenib therapy [52,53,54,55,56]
Summary
Hepatocellular carcinoma (HCC) is a leading cause of death worldwide [1,2]. In addition to liver transplantation, surgical resection, radiofrequency ablation (RFA), transarterial catheter chemoembolization (TACE), and tyrosine kinase inhibitors (TKIs) have been developed as standard treatments for each stage. The present review is conducted to focus on the useful predictive value of a newly developed assessment tool of hepatic function for prognosis with each modality for the treatment of patients with HCC. The Child–Pugh classification has been used worldwide for a long period as a standard assessment tool for hepatic reserve function [6] because it is easy for clinicians to remember and calculate (Table 1). Barcelona Clinic liver cancer staging system (BCLC) staging [8] therapeutic strategies for all HCC stages, and the subclassification for BCLC-B (intermediate) stage HCC for treatment guidance (Bolondi’s criteria [9] and Kindai criteria [10]) use Child–Pugh score/classification as an assessment method to evaluate the pretreatment hepatic reserve. Some weak points of the Child–Pugh classification have been pointed out, including subjective factors (ascites, encephalopathy), interrelated factors (serum albumin level, ascites), semi-quantitative characteristics, and a lack of statistical evidence (Table 1)
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