PMID- 29976502 OWN - NLM STAT- MEDLINE DCOM- 20190422 LR - 20190422 IS - 1879-355X (Electronic) IS - 0360-3016 (Linking) VI - 101 IP - 4 DP - 2018 Jul 15 TI - Baseline Albumin-Bilirubin (ALBI) Score in Western Patients With Hepatocellular Carcinoma Treated With Stereotactic Body Radiation Therapy (SBRT). PG - 900-909 LID - S0360-3016(18)30662-X [pii] LID - 10.1016/j.ijrobp.2018.04.011 [doi] AB - PURPOSE: To assess the baseline albumin-bilirubin (ALBI) score as a predictor of toxicity and survival in a prospective cohort of Western patients with hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT) in 2 prospective trials. METHODS AND MATERIALS: The study included 102 patients with Child-Pugh class A liver disease who received 6-fraction SBRT for HCC. Univariate and multivariable logistic regression investigated factors associated with toxicity, defined as an increase in Child-Pugh score >/= 2 within 3 months of SBRT. Univariate and multivariable Cox regression analyses investigated factors predictive of overall survival (OS). The ALBI score was analyzed as a continuous and binary variable in separate analyses. RESULTS: On multivariable analysis of toxicity, including the ALBI score as a continuous variable, the ALBI score (odds ratio [OR] per 0.1-unit increase, 1.51; 95% confidence interval [CI] 1.23-1.85; P = .00074), mean liver dose (OR, 1.31; 95% CI 1.02-1.68; P = .036), and dose received by 800 cm(3) of normal liver (OR, 1.10; 95% CI 1.01-1.20; P = .028) were significant. When the ALBI score was included as a dichotomous variable, the ALBI grade remained a significant predictor of toxicity (OR, 7.44; 95% CI 2.34-23.70; P = .00069). On multivariable analysis of OS, including the ALBI score as a continuous variable, the ALBI score (hazard ratio [HR] per 0.1-unit increase, 1.09; 95% CI 1.03-1.17; P = .004), tumor thrombus (HR, 1.94; 95% CI 1.23-3.07; P = .004), and treatment in trial 1 versus trial 2 (HR, 1.92; 95% CI 1.23-3.03; P = .004) were significant. Similarly, when the ALBI score was included as a binary variable, the ALBI grade, tumor thrombus, and trial were significant predictors of OS. When the ALBI score was considered, the Child-Pugh score (A6 vs A5) was not significant in multivariable models analyzing toxicity or survival. Concordance statistics indicated models containing the ALBI score were superior to those containing the Child-Pugh score. CONCLUSIONS: The baseline ALBI score was more discriminating than the Child-Pugh score in predicting OS and toxicity in patients with Child-Pugh class A liver disease. The ALBI score should be used as a factor for stratification in future HCC SBRT trials. CI - Copyright (c) 2018 Elsevier Inc. All rights reserved. FAU - Murray, Louise J AU - Murray LJ AD - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Sykes, Jenna AU - Sykes J AD - Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Brierley, James AU - Brierley J AD - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Kim, John J AU - Kim JJ AD - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Wong, Rebecca K S AU - Wong RKS AD - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Ringash, Jolie AU - Ringash J AD - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Craig, Tim AU - Craig T AD - Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Velec, Michael AU - Velec M AD - Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Lindsay, Patricia AU - Lindsay P AD - Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. FAU - Knox, Jennifer J AU - Knox JJ AD - Department of Medical Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada. FAU - Dawson, Laura A AU - Dawson LA AD - Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. Electronic address: Laura.Dawson@rmp.uhn.on.ca. LA - eng GR - 202477/CIHR/Canada PT - Clinical Trial PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180412 PL - United States TA - Int J Radiat Oncol Biol Phys JT - International journal of radiation oncology, biology, physics JID - 7603616 RN - 0 (Biomarkers) RN - 0 (Serum Albumin) RN - RFM9X3LJ49 (Bilirubin) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Bilirubin/*blood MH - Biomarkers/blood MH - Carcinoma, Hepatocellular/*blood/mortality/pathology/*radiotherapy MH - Chi-Square Distribution MH - Confidence Intervals MH - Dose Fractionation, Radiation MH - Female MH - Follow-Up Studies MH - Humans MH - Liver/radiation effects MH - Liver Cirrhosis/diagnosis MH - Liver Neoplasms/*blood/mortality/pathology/*radiotherapy MH - Logistic Models MH - Male MH - Middle Aged MH - Prospective Studies MH - Radiosurgery/*adverse effects MH - Serum Albumin/*analysis MH - Severity of Illness Index MH - Tumor Burden EDAT- 2018/07/07 06:00 MHDA- 2019/04/23 06:00 CRDT- 2018/07/07 06:00 PHST- 2017/08/23 00:00 [received] PHST- 2018/03/18 00:00 [revised] PHST- 2018/04/04 00:00 [accepted] PHST- 2018/07/07 06:00 [entrez] PHST- 2018/07/07 06:00 [pubmed] PHST- 2019/04/23 06:00 [medline] AID - S0360-3016(18)30662-X [pii] AID - 10.1016/j.ijrobp.2018.04.011 [doi] PST - ppublish SO - Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):900-909. doi: 10.1016/j.ijrobp.2018.04.011. Epub 2018 Apr 12.