Cryptogenic hepatocellular carcinoma: characteristics, outcome, and prognostic role of albumin-bilirubin (ALBI) grade vs easy ALBI grade.

Abstract

BACKGROUND:

The characteristics and prognosis of cryptogenic hepatocellular carcinoma (HCC) remain unclear. The albumin-bilirubin (ALBI) grade and its updated version, the easy ALBI (EZ-ALBI) grade, are important prognostic predictors for HCC. We aimed to investigate the long-term survival of patients with cryptogenic HCC and the prognostic role of ALBI and EZ-ALBI grade in these patients.

METHODS:

A prospective cohort of 2,937 HCC patients with viral or cryptogenic etiology were retrospectively analyzed. The multivariate Cox model was used to determine prognostic predictors.

RESULTS:

Cryptogenic HCC patients were often older and diabetic, had lower serum ɑ-fetoprotein (AFP) levels, larger tumor burden, poor performance status, advanced cancer stage, and received non-curative treatments compared with hepatitis B or C-related HCC. The Cox analysis showed that age > 65 years, serum AFP > 400 ng/mL, presence of vascular invasion or distant metastasis, presence of ascites, performance status 2-4, ALBI grade 2 and 3, EZ-ALBI grade 2 and 3, and non-curative treatment, were independent predictors of decreased survival in cryptogenic HCC (p < .001). Significant survival differences were found across ALBI grade and EZ-ALBI grade in cryptogenic HCC and subgroup patients receiving curative or non-curative treatments. The Cancer of Liver Italian Program was the best staging system for patients with cryptogenic HCC.

CONCLUSIONS:

Patients with cryptogenic HCC have a larger tumor burden and advanced cancer stage at disease presentation compared with those with viral HCC. The ALBI and EZ-ALBI score are robust models to evaluate liver functional reserve for these patients independent of treatment modality.

• Authors: Shu-Yein Ho, Mei-Hsia Yuan, Po-Hong Liu, Chia-Yang Hsu, Yi-Hsiang Huang, Jia-I Liao, Chien-Wei Su, Chia-Lin Wang, Ming-Chih Hou, Teh-Ia Huo
• Journal: Scandinavian journal of gastroenterology (Scand J Gastroenterol) Vol. 58 Issue 1 Pg. 61-69 (01 2023) ISSN: 1502-7708 [Electronic] England
• PMID: 35830511 (Publication Type: Journal Article)

Chemical References

• Bilirubin
• alpha-Fetoproteins
• Serum Albumin

Topics

• Humans
• Aged
• Carcinoma, Hepatocellular
• Prognosis
• Bilirubin
• Liver Neoplasms
• alpha-Fetoproteins
• Retrospective Studies
• Prospective Studies
• Serum Albumin (analysis)