Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade

Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival...

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Veröffentlicht in:	Journal of clinical oncology Jg. 33; H. 6; S. 550
Hauptverfasser:	Johnson, Philip J, Berhane, Sarah, Kagebayashi, Chiaki, Satomura, Shinji, Teng, Mabel, Reeves, Helen L, O'Beirne, James, Fox, Richard, Skowronska, Anna, Palmer, Daniel, Yeo, Winnie, Mo, Frankie, Lai, Paul, Iñarrairaegui, Mercedes, Chan, Stephen L, Sangro, Bruno, Miksad, Rebecca, Tada, Toshifumi, Kumada, Takashi, Toyoda, Hidenori
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 20.02.2015
Schlagworte:	Aged Bilirubin - blood Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - physiopathology Cohort Studies Female Humans Liver - physiopathology Liver Neoplasms - blood Liver Neoplasms - pathology Liver Neoplasms - physiopathology Male Middle Aged Models, Biological Neoplasm Grading Neoplasm Staging Serum Albumin - metabolism
ISSN:	1527-7755, 1527-7755
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Abstract	Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade. We developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501). The model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function. The ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.
AbstractList	Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade. We developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501). The model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function. The ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade. Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade.PURPOSEMost patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P) grade. In this international collaboration, we identify objective measures of liver function/dysfunction that independently influence survival in patients with HCC and then combine these into a model that could be compared with the conventional C-P grade.We developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501).PATIENTS AND METHODSWe developed a simple model to assess liver function, based on 1,313 patients with HCC of all stages from Japan, that involved only serum bilirubin and albumin levels. We then tested the model using similar cohorts from other geographical regions (n = 5,097) and other clinical situations (patients undergoing resection [n = 525] or sorafenib treatment for advanced HCC [n = 1,132]). The specificity of the model for liver (dys)function was tested in patients with chronic liver disease but without HCC (n = 501).The model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function.RESULTSThe model, the Albumin-Bilirubin (ALBI) grade, performed at least as well as the C-P grade in all geographic regions. The majority of patients with HCC had C-P grade A disease at presentation, and within this C-P grade, ALBI revealed two classes with clearly different prognoses. Its utility in patients with chronic liver disease alone supported the contention that the ALBI grade was indeed an index of liver (dys)function.The ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.CONCLUSIONThe ALBI grade offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in HCC that has been extensively tested in an international setting. This new model eliminates the need for subjective variables such as ascites and encephalopathy, a requirement in the conventional C-P grade.
Author	Miksad, Rebecca Reeves, Helen L Iñarrairaegui, Mercedes Mo, Frankie Teng, Mabel Tada, Toshifumi Kagebayashi, Chiaki Sangro, Bruno Johnson, Philip J Toyoda, Hidenori Fox, Richard Yeo, Winnie Kumada, Takashi Chan, Stephen L Berhane, Sarah Skowronska, Anna Palmer, Daniel Satomura, Shinji O'Beirne, James Lai, Paul
Author_xml	– sequence: 1 givenname: Philip J surname: Johnson fullname: Johnson, Philip J email: Philip.Johnson@liverpool.ac.uk organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan. Philip.Johnson@liverpool.ac.uk – sequence: 2 givenname: Sarah surname: Berhane fullname: Berhane, Sarah organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 3 givenname: Chiaki surname: Kagebayashi fullname: Kagebayashi, Chiaki organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 4 givenname: Shinji surname: Satomura fullname: Satomura, Shinji organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 5 givenname: Mabel surname: Teng fullname: Teng, Mabel organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 6 givenname: Helen L surname: Reeves fullname: Reeves, Helen L organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 7 givenname: James surname: O'Beirne fullname: O'Beirne, James organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 8 givenname: Richard surname: Fox fullname: Fox, Richard organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 9 givenname: Anna surname: Skowronska fullname: Skowronska, Anna organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 10 givenname: Daniel surname: Palmer fullname: Palmer, Daniel organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 11 givenname: Winnie surname: Yeo fullname: Yeo, Winnie organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 12 givenname: Frankie surname: Mo fullname: Mo, Frankie organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 13 givenname: Paul surname: Lai fullname: Lai, Paul organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 14 givenname: Mercedes surname: Iñarrairaegui fullname: Iñarrairaegui, Mercedes organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 15 givenname: Stephen L surname: Chan fullname: Chan, Stephen L organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 16 givenname: Bruno surname: Sangro fullname: Sangro, Bruno organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 17 givenname: Rebecca surname: Miksad fullname: Miksad, Rebecca organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 18 givenname: Toshifumi surname: Tada fullname: Tada, Toshifumi organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 19 givenname: Takashi surname: Kumada fullname: Kumada, Takashi organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan – sequence: 20 givenname: Hidenori surname: Toyoda fullname: Toyoda, Hidenori organization: Philip J. Johnson, Sarah Berhane, and Daniel Palmer, University of Liverpool, Liverpool; Philip J. Johnson and Daniel Palmer, The Clatterbridge Cancer Centre National Health Service (NHS) Foundation Trust, Bebington; Mabel Teng, Addenbrooke's Hospital, University of Cambridge, Cambridge; Helen L. Reeves, Northern Institute for Cancer Research and the Hepatopancreatobiliary Multidisciplinary Team, Newcastle upon Tyne NHS Foundation Trust, The Freeman Hospital, Newcastle upon Tyne; James O'Beirne, The Sheila Sherlock Liver Centre, Royal Free Hospital, London; Richard Fox and Anna Skowronska, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Chiaki Kagebayashi and Shinji Satomura, Wako Life Sciences, Mountain View, CA; Rebecca Miksad, Beth Israel Deaconess Medical Center, Institute for Technology Assessment, Massachusetts General Hospital, and Harvard Medical School, Boston, MA; Winnie Yeo, Frankie Mo, and Stephen L. Chan, State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Chinese University of Hong Kong, Hong Kong Cancer Institute; Paul Lai, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; Mercedes Iñarrairaegui and Bruno Sangro, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Pamplona, Spain; Toshifumi Tada, Takashi Kumada, and Hidenori Toyoda, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25512453$$D View this record in MEDLINE/PubMed
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Snippet	Most patients with hepatocellular carcinoma (HCC) have associated chronic liver disease, the severity of which is currently assessed by the Child-Pugh (C-P)...
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SubjectTerms	Aged Bilirubin - blood Carcinoma, Hepatocellular - blood Carcinoma, Hepatocellular - pathology Carcinoma, Hepatocellular - physiopathology Cohort Studies Female Humans Liver - physiopathology Liver Neoplasms - blood Liver Neoplasms - pathology Liver Neoplasms - physiopathology Male Middle Aged Models, Biological Neoplasm Grading Neoplasm Staging Serum Albumin - metabolism
Title	Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade
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