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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

The significance of ALBI score in gastric cancer (GC) after radical resection has not been elucidated.

Research objectives

To analyze the significance of ALBI score in GC after curative gastrectomy.

Research methods

We retrospectively evaluated all GC patients who underwent gastrectomy between 2009 and 2021. ALBI score was calculated as follows: (log10 bilirubin × 0.660) + (albumin × -0.085). The receiver operating characteristic (ROC) curve with area under the curve (AUC) was plotted to evaluate the ability of ALBI score in predicting recurrence or death. Patients were divided into low-ALBI and high-ALBI groups for analysis, based on the optimal cutoff value determined by ROC curve.

Research results

A total of 361 patients were included. The AUC for ALBI score was 0.617, 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, lower hemoglobin level, American Society of Anesthesiologists classification III/IV, and D1 lymphadenectomy 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 stage (pTNM). Major postoperative complication and 30- and 90-d mortality were higher in high-ALBI patients. In survival analysis, the high-ALBI group had worse disease-free survival and overall survival compared to those with low-ALBI. When stratified by pTNM, the survival difference between ALBI groups was maintained in stage I/II and stage III GC. Multivariate analysis demonstrated that high-ALBI was an independent factor associated to worse survival.

Research conclusions

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.

Research perspectives

ALBI score is able to predict short-term and long-term outcomes of patients, and can be applied as a prognostic factor for GC. The ALBI is a simple and reproducible parameter that allows the risk stratification of patients within the pTNM stages, and may be an additional useful tool for decision-making regarding treatment and follow-up individualization. Thus, our findings can be evaluated in other cohorts, and validated in other series of cases study.