Newly Developed Modified ALBI Grade Shows Better Prognostic and Predictive Value for Hepatocellular Carcinoma

Two of its five constituent factors, hepatic encephalopathy and ascites, are subjective, and serum albumin levels and ascites are confounding factors [1]. [...]the distribution of patients across grades is heavily skewed, with Child-Pugh A patients accounting for about two-thirds of all patients (Table 1). A Japanese cohort study showed that this ALBI grade enables more detailed prognostic classification than the Child-Pugh grade; in addition, other studies in Chinese, European, and American cohorts showed that the performance of the ALBI for stratifying liver function in these populations was reproducible. [...]the ALBI grade and ALBI score are now becoming used widely in routine clinical practice. [...]looking at the data published to date, the report from the 23rd biannual survey of the Liver Cancer Study Group of Japan [8], as well as other recent studies [5, 9], show that the Child-Pugh grade was heavily skewed, with 72–85% of HCC patients graded as A; by contrast, the mALBI grade was well stratified, with 32–39% of patients graded as 1; 23–25% as 2a; 32–40% as 2b; and 3–7% as 3 (Table 2). Especially in Japan, the number of ALBI grade 3 HCC patients is very small, ranging from 3% to 7% (Table 2). [...]in practice, this makes the conventional ALBI grade essentially a 2-category system comprising ALBI grades 1 and 2. Consistency of Prognostic and Predictive Value of mALBI Grade with Respect to Various Treatment Options Survey results from the Liver Cancer Study Group of Japan [8] showed that Child-Pugh grade (Fig. 1a) performed well with respect to stratification of 85,636 patients with HCC; however, the 4-category mALBI grade system performed even better (Fig. 1b).