Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1125-1137
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1125
Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy
Daniel Jose Szor, Marina Alessandra Pereira, Marcus Fernando Kodama Pertille Ramos, Francisco Tustumi, Andre Roncon Dias, Bruno Zilberstein, Ulysses Ribeiro Jr
Daniel Jose Szor, Marina Alessandra Pereira, Marcus Fernando Kodama Pertille Ramos, Francisco Tustumi, Andre Roncon Dias, Bruno Zilberstein, Ulysses Ribeiro Jr, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
Author contributions: Szor DJ contributed to study design, data retrieval, statistical analysis, critical analysis, and draft of the manuscript; Pereira MA contributed to data retrieval, statistical analysis, critical analysis, and draft of the manuscript; Ramos MFKP, Tustumi F, and Dias AR contributed to data retrieval, critical analysis, and review of the manuscript; Zilberstein B contributed to critical analysis and review of the manuscript; Ribeiro Jr U contributed to implementation of the research, critical analysis, and review of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Hospital Ethics Committee and Registered Online https://plataformabrasil.saude.gov.br (approval No. 50971821.8.0000.0068).
Informed consent statement: Informed consent was waived by the local ethics committee given the retrospective nature of the study.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel Jose Szor, MS, PhD, Postdoc, Professor, Surgeon, Surgical Oncologist, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, 251 Av Dr Arnaldo, Sao Paulo 01246000, Brazil. danszor@gmail.com
Received: January 10, 2023
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
Abstract
BACKGROUND

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.

AIM

To evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.

METHODS

Patients with GC who underwent curative intended gastrectomy were retrospectively evaluated from our prospective database. ALBI score was calculated as follows: (log10 bilirubin × 0.660) + (albumin × -0.085). The receiver operating characteristic curve with area under the curve (AUC) was plotted to evaluate the ability of ALBI score in predicting recurrence or death. The optimal cutoff value was determined by maximizing Youden’s index, and patients were divided into low and high-ALBI groups. The Kaplan-Meier curve was used to analyze the survival, and the log-rank test was used for comparison between groups.

RESULTS

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.

CONCLUSION

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.

Keywords: Stomach neoplasms, Adenocarcinoma, Albumin-bilirubin, Biomarker, Prognosis, 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.