Prognosis Using Modified Albumin-Bilirubin Grade in Resected Biliary Tract Cancer: A Multicenter Propensity
Toru Takahashi1, Hiroaki Yanagimoto1, Masayuki Akita1
1Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Background/Aim:
Currently, the modified albumin-bilirubin (mALBI) grade, a novel liver function assessment, is used as a prognostic factor in many areas of gastrointestinal cancer. We evaluated whether mALBI grade predicted survival in a large multicenter cohort of patients who underwent curative-intent resection for biliary tract cancer (BTC).
Patients And Methods:
We retrospectively analyzed data for 634 patients who underwent curative resection for BTC at four centers during 2001-2023. The mALBI grade was calculated from preoperative albumin and total bilirubin levels. Cox proportional hazards regression was used to assess the association of mALBI grade with overall survival (OS) and recurrence-free survival (RFS) in a propensity score-matched cohort. The mALBI grade was defined by subdividing ALBI grade 2 at a cutoff of -2.27; patients with mALBI grades 1-2a were classified as the low mALBI group, and those with grades 2b-3 as the high mALBI group.
Results:
After propensity score-matching, the high mALBI group remained associated with poorer OS (44 vs. 70 months; p=0.015) than the low mALBI group. Multivariate analysis revealed that high mALBI grade was independently associated with poor OS (hazard ratio=1.584, 95% confidence interval=1.077-2.331; p=0.020) and RFS (hazard ratio =1.447, 95% confidence interval=1.023-2.046, p=0.037).
Conclusion:
A high mALBI grade was associated with shorter OS and RFS in patients with resected BTC. Preoperative mALBI grade is an important prognostic indicator for risk stratification and prognostic evaluation.