Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1125
Peer-review started: January 10, 2023
First decision: February 20, 2023
Revised: February 21, 2023
Accepted: April 17, 2023
Article in press: April 17, 2023
Published online: June 27, 2023
Albumin-bilirubin (ALBI) score is an indicator of liver dysfunction and is useful for predicting prognosis of hepatocellular carcinomas. Currently, this liver function index has been used to predict prognosis in other neoplasms. However, the significance of ALBI score in gastric cancer (GC) after radical resection has not been elucidated.
To evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.
Patients with GC who underwent curative intended gastrectomy were retro
A total of 361 patients (235 males) were enrolled. The median ALBI value for the entire cohort was -2.89 (IQR -3.13; -2.59). The AUC for ALBI score was 0.617 (95%CI: 0.556-0.673, P < 0.001), and the cutoff value was -2.82. Accordingly, 211 (58.4%) patients were classified as low-ALBI group and 150 (41.6%) as high-ALBI group. Older age (P = 0.005), lower hemoglobin level (P < 0.001), American Society of Anesthesiologists classification III/IV (P = 0.001), and D1 lymphadenectomy P = 0.003) were more frequent in the high-ALBI group. There was no difference between both groups in terms of Lauren histological type, depth of tumor invasion (pT), presence of lymph node metastasis (pN), and pathologic (pTNM) stage. Major postoperative complication, and mortality at 30 and 90 days were higher in the high-ALBI patients. In the survival analysis, the high-ALBI group had worse disease-free survival (DFS) and overall survival (OS) compared to those with low-ALBI (P < 0.001). When stratified by pTNM, the difference between ALBI groups was maintained in stage I/II and stage III CG for DFS (P < 0.001 and P = 0.021, respectively); and for OS (P < 0.001 and P = 0.063, respectively). In multivariate analysis, total gastrectomy, advanced pT stage, presence of lymph node metastasis and high-ALBI were independent factors associated with worse survival.
The preoperative ALBI score is able to predict the outcomes of patients with GC, where high-ALBI patients have worse prognosis. Also, ALBI score allows risk stratification of patients within the same pTNM stages, and represents an independent risk factor associated with survival.
Core Tip: The present study evaluates the clinical impact of the preoperative albumin-bilirubin (ALBI) score in patients with gastric cancer who received curative treatment. We found that ALBI score is able to predict short-term and long-term outcomes of patients, and can be applied as a prognostic factor for gastric cancer. The ALBI is a simple and reproducible parameter that allows the risk stratification of patients within the pathologic stage stages, and may be an additional useful tool for decision-making regarding treatment and follow-up individualization.