Extending the reach of the ALBI score for primary hepatic malignancies: Does ALBI work for cholangiocarcinoma?

Purpose:

While several prognostic scores for patients with resectable intrahepatic cholangiocarcinoma (ICC) exist, patients with non-resectable ICC are less well studied. Recently, the albumin-bilirubin (ALBI) score was shown to be a prognostic marker for patients with resectable ICC, too. Aim of this study was evaluate the prognostic impact of the ALBI score on overall survival (OS) for patients with non-resectable ICC.

Methods and materials:

Between 1997 – 2018, 417 patients with ICC were referred to our tertiary care centre and were retrospectively identified out of a dedicated clinical database, of whom 158 patients were non-resectable and could be included in this study. The ALBI score [(log10 bilirubin × 0.66) + (albumin ×-0.085), with bilirubin in µmol/L and albumin in g/L] was calculated and compared to the current UICC staging system regarding its predictive ability for OS. Moreover, the ALBI score was compared to established risk fators and imaging parameters using multivariate Cox hazard regression.

Results:

Median OS was 13.8 months, 6.9 months, and 1.8 months for patients with ALBI grade 1, 2, and 3 respectively (p < 0.001). Concordance index (C-index) calculation yielded 0.65 compared to a c-index of 0.62 for the UICC staging system. In multivariate analysis including tumour number and spread, laboratory markers, and subsequent treatment, the ALBI score remained a significant predictive factor for survival (hazard ratio 1.5 for grade 2 and 3.0 for grade 3, p = 0.08 and p = 0.001, respectively).

Conclusion:

The ALBI score was highly predictive for OS in patients with non-resectable ICC, despite having been developed for patients with hepatocellular carcinoma. Due to its simplicity, the ALBI score can easily be applied in clinical routine.