Liver function assessment according to the Albumin–Bilirubin (ALBI) grade in sorafenib-treated patients with advanced hepatocellular carcinoma

Background: The Albumin–Bilirubin (ALBI) grade has been proposed as a new, simple, and objective method of assessing liver function. However, there is lack of data in sorafenib-treated patients with advanced hepatocellular carcinoma (HCC). Methods: We evaluated the correlations between the ALBI grade and Child–Pugh score, adverse events, and survival in 89 patients with advanced HCC who were prospectively treated with sorafenib. Results: Majority of patients with ALBI grade 1 (14/15 patients, 93 %) had a Child–Pugh score of 5. Patients with ALBI grade 2 had a wide range of liver function according to the Child–Pugh scores, with scores of 5, 6, 7, and ≥8. We divided ALBI grade 2 patients into ALBI grade 2A and 2B groups according to the median ALBI score among patients with ALBI grade 2. Although no significant difference was observed, the incidence of liver dysfunction in sorafenib-treated patients with ALBI grades 1, 2A, and 2B was 7 %, 19 %, and 35 %, respectively. Overall survival in the ALBI grade 2B group was significantly shorter than that in the ALBI grade 1 and 2A groups. Thus, ALBI grade 2B was an independent predictor of poor prognosis in addition to elevated serum aspartate aminotransferase levels, increased serum alpha-fetoprotein level, and macrovascular invasion. Conclusion: Sorafenib may be indicated for all patients with advanced HCC and ALBI grade 1 and for some with ALBI grade 2. The subdivision of patients with ALBI grade 2 increases the utility of ALBI in identifying patients indicated for sorafenib therapy.