A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma.

Background & Aims The Albumin-Bilirubin ( ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma ( HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh ( CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification. Methods We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival ( OS) was analysed using the Kaplan -Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion. Results Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively ( P < 0.001), Hazard Ratio ( HR) = 1.60 (95% CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively ( P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population. Conclusions Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy. [ABSTRACT FROM AUTHOR]