Easier Grading, Better Guidance

The study authors found that the ALBI grade, which relies on two common laboratory tests, was easier to determine than the Child-Pugh score, which requires clinical evaluation of the patient, and they developed a simple nomogram for determining the ALBI grade from the albumin and bilirubin values.

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They also found that the ALBI grade had greater usefulness in HCC than the Child-Pugh score. In several categories of patients, the ALBI grading system was able to identify two or three distinct prognostic groups, whereas Child-Pugh grades A and B showed considerable overlap in clinical outcomes.

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For example, when Child-Pugh grade A patients, all of whom would be assumed to have similar risk, were reclassified into ALBI grades, those in ALBI grade 1 had median survival 10 months longer than patients in ALBI grade 2.

In an editorial accompanying the published article, Jennifer J. Knox, MD, MSc, FRCPC, of the University of Toronto in Toronto, ON, Canada, wrote, “Johnson [and colleagues] should be congratulated for addressing a problematic area, engaging an international community and, in so doing, simplifying a complex clinical problem that has been in need of clarification for decades.”2


  1. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach—the ALBI grade. J Clin Oncol. 2014 Dec 15 [Epub ahead of print]. doi: 10.1200/JCO.2014.57.9151.
  2. Knox JJ. Addressing the interplay of liver disease and hepatocellular carcinoma on patient survival: the ALBI scoring model. J Clin Oncol. 2014 15 Dec 2014 [Epub ahead of print]. doi: 10.1200/JCO.2014.59.0521.