Baseline albumin-bilirubin (ALBI) in Western patients with hepatocellular carcinoma treated with stereotactic body radiotherapy (SBRT)

Publication date: Available online 12 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Louise J. Murray, Jenna Sykes, James Brierley, John J. Kim, Rebecca K.S. Wong, Jolie Ringash, Tim Craig, Michael Velec, Patricia Lindsay, Jennifer J. Knox, Laura A. Dawson
PurposeTo assess the baseline albumin-bilirubin (ALBI) grade as a predictor of toxicity and survival in a prospective cohort of Western patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT) in two prospective trials.Methods and materials102 patients with Child Pugh A liver disease who received 6-fraction SBRT for HCC were included. Univariate and multivariable logistic regression investigated factors associated with toxicity, defined as an increase in Child Pugh score of ≥2 within 3 months of SBRT. Univariate and multivariable Cox regression investigated factors predictive of overall survival (OS). ALBI was analysed as a continuous and binary variable in separate analyses.ResultsOn multivariable analysis of toxicity, including ALBI as a continuous variable, ALBI (odds ratio (OR) per 0.1 unit increase: 1.51 (95% confidence interval (CI):1.23-1.85, p=0.00074), mean liver dose (OR:1.31 (95%CI:1.02-1.68), p=0.036) and dose received by 800cc of normal liver (D800) (OR:1.10 (95%CI:1.01-1.20, p=0.028), were significant. When including ALBI as a dichotomous variable, ALBI grade remained a significant predictor of toxicity (OR:7.44 (95%CI:2.34-23.70, p=0.00069). On multivariable analysis of OS, including ALBI as a continuous variable, ALBI (Hazard ratio (HR) per 0.1 increase: 1.09 (95%CI:1.03-1.17, p=0.004), tumour thrombus (HR:1.94 (95%CI:1.23-3.07, p=0.004) and being treated in Trial 1 vs. 2 (HR:1.92 (95%CI:1.23-3.03), p=0.004) were significant. Similarly, when including ALBI as a binary variable, ALBI, tumour thrombus and trial were significant predictors of OS. When ALBI was considered, Child Pugh score (A6 vs A5) was not significant in multivariable models analysing toxicity or survival. Concordance statistics indicated models containing ALBI were superior to those containing Child Pugh.ConclusionsBaseline ALBI was more discriminating than Child Pugh score in predicting OS and toxicity in patients with Child Pugh A liver disease. ALBI should be used as a factor for stratification in future HCC SBRT trials.

Teaser

In a prospective series of 102 Western patients with Child Pugh A hepatocellular carcinoma (HCC) managed with stereotactic body radiotherapy (SBRT), the baseline albumin-bilirubin (ALBI) score was evaluated as a predictor of survival and hepatic toxicity. ALBI was an independent significant predictor of toxicity and survival, and was more discriminating than Child Pugh score. Thus, ALBI warrants further investigation and should be included as a factor for stratification in future clinical trials.


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