Background The albumin-bilirubin (ALBI) score, used for predicting outcomes after hepatocellular carcinoma (HCC) resection, does not directly capture liver cell damage or biliary obstruction. Gamma-glutamyl transferase (GGT), which reflects hepatic oxidative stress and inflammation, may complement the ALBI score. We sought to develop the ALBI-GGT score, a composite prognostic tool, and evaluate its performance to predict long-term outcomes among patients undergoing HCC resection. Methods Patients undergoing curative-intent HCC resection (2000-2023) were identified from an international, multi-institutional database. The cohort was divided into training (65%) and testing cohorts (35%). Multivariable Cox analysis examined the association of ALBI-GGT score with overall survival (OS). Results Among 759 patients, the median ALBI score was -2.78 (-3.02 to -2.48), and the median GGT was 55.0 U/L (31.0-93.0). On multivariable analysis, ALBI score (hazard ratio [HR], 1.473 [1.112-1.950]; P =.007) and GGT (HR, 1.007 [1.004-1.010]; P <.001) were predictors of overall mortality, alongside tumor burden score (HR, 1.051 [1.015-1.090]; P =.006) and American Society of Anesthesiologists class >2 (HR, 1.473 [1.005-2.161]; P =.047). There was a near-linear correlation between increasing ALBI scores and GGT and higher hazards of death. The ALBI-GGT score demonstrated the highest predictive accuracy in the testing set (concordance index, 0.68 [0.58-0.72]), outperforming the ALBI score (0.62 [0.56-0.69]) and GGT (0.65 [0.58-0.72]). The ALBI-GGT achieved the lowest Akaike and Bayesian information criteria. Time-dependent area under the curve (AUC) analysis demonstrated consistent superiority over 0 to 60 months. At 1-, 3-, and 5-years, the ALBI-GGT score had AUCs of 0.782, 0.725, and 0.688, respectively, outperforming ALBI score and GGT. The ALBI-GGT score was able to stratify patients into distinct prognostic groups (5-year OS, low ALBI-GGT [85.0%] vs intermediate ALBI-GGT [65.8%] vs high ALBI-GGT [56.8%]; P <.001). Conclusion ALBI score alone may be insufficient to prognostically stratify patients with HCC. Combining ALBI score with GGT was a superior tool to stratify patients relative to long-term survival. (c) 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Development and validation of the albumin-bilirubin gamma-glutamyl transferase score for enhanced prognostic accuracy after hepatocellular carcinoma resection
Ruzzenente, Andrea;
2025-01-01
Abstract
Background The albumin-bilirubin (ALBI) score, used for predicting outcomes after hepatocellular carcinoma (HCC) resection, does not directly capture liver cell damage or biliary obstruction. Gamma-glutamyl transferase (GGT), which reflects hepatic oxidative stress and inflammation, may complement the ALBI score. We sought to develop the ALBI-GGT score, a composite prognostic tool, and evaluate its performance to predict long-term outcomes among patients undergoing HCC resection. Methods Patients undergoing curative-intent HCC resection (2000-2023) were identified from an international, multi-institutional database. The cohort was divided into training (65%) and testing cohorts (35%). Multivariable Cox analysis examined the association of ALBI-GGT score with overall survival (OS). Results Among 759 patients, the median ALBI score was -2.78 (-3.02 to -2.48), and the median GGT was 55.0 U/L (31.0-93.0). On multivariable analysis, ALBI score (hazard ratio [HR], 1.473 [1.112-1.950]; P =.007) and GGT (HR, 1.007 [1.004-1.010]; P <.001) were predictors of overall mortality, alongside tumor burden score (HR, 1.051 [1.015-1.090]; P =.006) and American Society of Anesthesiologists class >2 (HR, 1.473 [1.005-2.161]; P =.047). There was a near-linear correlation between increasing ALBI scores and GGT and higher hazards of death. The ALBI-GGT score demonstrated the highest predictive accuracy in the testing set (concordance index, 0.68 [0.58-0.72]), outperforming the ALBI score (0.62 [0.56-0.69]) and GGT (0.65 [0.58-0.72]). The ALBI-GGT achieved the lowest Akaike and Bayesian information criteria. Time-dependent area under the curve (AUC) analysis demonstrated consistent superiority over 0 to 60 months. At 1-, 3-, and 5-years, the ALBI-GGT score had AUCs of 0.782, 0.725, and 0.688, respectively, outperforming ALBI score and GGT. The ALBI-GGT score was able to stratify patients into distinct prognostic groups (5-year OS, low ALBI-GGT [85.0%] vs intermediate ALBI-GGT [65.8%] vs high ALBI-GGT [56.8%]; P <.001). Conclusion ALBI score alone may be insufficient to prognostically stratify patients with HCC. Combining ALBI score with GGT was a superior tool to stratify patients relative to long-term survival. (c) 2025 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
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