A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma

Julien Edeline; Jean-Frédéric Blanc; Philip Johnson; Boris Campillo-Gimenez; Paul Ross; Yuk Ma; Judy King; Richard A Hubner; Kate Sumpter; Suzanne Darby; Jeff Evans; Chinenye Iwuji; Daniel Swinson; Peter Collins; Kinnari Patel; Iqtedar Muazzam; Daniel H Palmer; Tim Meyer

doi:10.1111/liv.13170

A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma

Julien Edeline, Jean-Frédéric Blanc, Philip Johnson, Boris Campillo-Gimenez, Paul Ross, Yuk Ma, Judy King, Richard A Hubner, Kate Sumpter, Suzanne Darby, Jeff Evans, Chinenye Iwuji, Daniel Swinson, Peter Collins, Kinnari Patel, Iqtedar Muazzam, Daniel H Palmer, Tim Meyer

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

52 Citations (Scopus)

Abstract

BACKGROUND & AIMS: The Albumin-Bilirubin (ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification.

METHODS: We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival (OS) was analysed using the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion.

RESULTS: Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P < 0.001), Hazard Ratio (HR) = 1.60 (95%CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population.

CONCLUSIONS: Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy.

Original language	English
Pages (from-to)	1821-1828
Number of pages	8
Journal	Liver International
Volume	36
Issue number	12
Early online date	22 Jun 2016
DOIs	https://doi.org/10.1111/liv.13170
Publication status	Published - Dec 2016

Keywords

albumin
bilirubin
cirrhosis
liver function
prognosis

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10.1111/liv.13170

http://discovery.ucl.ac.uk/1496362/1/Meyer_ALBI%20Child%20HCC%20sorafenib%20Liver%20Int%20Revision%20Final.pdf

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Edeline, J., Blanc, J.-F., Johnson, P., Campillo-Gimenez, B., Ross, P., Ma, Y., King, J., Hubner, R. A., Sumpter, K., Darby, S., Evans, J., Iwuji, C., Swinson, D., Collins, P., Patel, K., Muazzam, I., Palmer, D. H., & Meyer, T. (2016). A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma. Liver International, 36(12), 1821-1828. https://doi.org/10.1111/liv.13170

@article{9cfe53e03f8647dca44dbd0817caa715,

title = "A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma",

abstract = "BACKGROUND & AIMS: The Albumin-Bilirubin (ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification.METHODS: We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival (OS) was analysed using the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion.RESULTS: Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P < 0.001), Hazard Ratio (HR) = 1.60 (95%CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population.CONCLUSIONS: Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy.",

keywords = "albumin, bilirubin, cirrhosis, liver function, prognosis",

author = "Julien Edeline and Jean-Fr{\'e}d{\'e}ric Blanc and Philip Johnson and Boris Campillo-Gimenez and Paul Ross and Yuk Ma and Judy King and Hubner, {Richard A} and Kate Sumpter and Suzanne Darby and Jeff Evans and Chinenye Iwuji and Daniel Swinson and Peter Collins and Kinnari Patel and Iqtedar Muazzam and Palmer, {Daniel H} and Tim Meyer",

note = "{\textcopyright} 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",

year = "2016",

month = dec,

doi = "10.1111/liv.13170",

language = "English",

volume = "36",

pages = "1821--1828",

journal = "Liver International",

issn = "1478-3223",

publisher = "Wiley",

number = "12",

}

Edeline, J, Blanc, J-F, Johnson, P, Campillo-Gimenez, B, Ross, P, Ma, Y, King, J, Hubner, RA, Sumpter, K, Darby, S, Evans, J, Iwuji, C, Swinson, D, Collins, P, Patel, K, Muazzam, I, Palmer, DH & Meyer, T 2016, 'A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma', Liver International, vol. 36, no. 12, pp. 1821-1828. https://doi.org/10.1111/liv.13170

TY - JOUR

T1 - A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma

AU - Edeline, Julien

AU - Blanc, Jean-Frédéric

AU - Johnson, Philip

AU - Campillo-Gimenez, Boris

AU - Ross, Paul

AU - Ma, Yuk

AU - King, Judy

AU - Hubner, Richard A

AU - Sumpter, Kate

AU - Darby, Suzanne

AU - Evans, Jeff

AU - Iwuji, Chinenye

AU - Swinson, Daniel

AU - Collins, Peter

AU - Patel, Kinnari

AU - Muazzam, Iqtedar

AU - Palmer, Daniel H

AU - Meyer, Tim

PY - 2016/12

Y1 - 2016/12

N2 - BACKGROUND & AIMS: The Albumin-Bilirubin (ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification.METHODS: We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival (OS) was analysed using the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion.RESULTS: Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P < 0.001), Hazard Ratio (HR) = 1.60 (95%CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population.CONCLUSIONS: Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy.

AB - BACKGROUND & AIMS: The Albumin-Bilirubin (ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification.METHODS: We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival (OS) was analysed using the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion.RESULTS: Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P < 0.001), Hazard Ratio (HR) = 1.60 (95%CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population.CONCLUSIONS: Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy.

KW - albumin

KW - bilirubin

KW - cirrhosis

KW - liver function

KW - prognosis

U2 - 10.1111/liv.13170

DO - 10.1111/liv.13170

M3 - Article

C2 - 27214151

SN - 1478-3223

VL - 36

SP - 1821

EP - 1828

JO - Liver International

JF - Liver International

IS - 12

ER -

A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma

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Keywords

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