Prognostic value of ALBI score in lung cancer patients with liver metastases and hepatic failure: a single-center experience

Year 2025, Volume: 7 Issue: 4, 501 - 505, 28.07.2025

Serkan Yaşar , Mustafa Büyükkör , Fatih Tay , Bediz Kurt İnci , Berkan Karabuga , Necla Demir , Ayşe Ocak Duran

Abstract

Aims: Lung cancer remains the leading cause of cancer-related mortality worldwide, with especially poor outcomes in the metastatic stage. Liver metastases and subsequent liver failure significantly worsen prognosis. Accurate risk stratification is therefore essential in this setting. The albumin-bilirubin (ALBI) score, a simple and objective indicator of liver function, may aid in prognostic evaluation. Unlike previous studies, this study specifically focuses on lung cancer patients with liver failure, a clinically distinct and high-risk subgroup.
Methods: Clinicopathological data and laboratory parameters were retrospectively retrieved from the hospital information system for patients with histologically confirmed lung cancer and concurrent liver metastases complicated by liver failure. ALBI score was calculated based on peripheral blood test results using the formula: (0.66×log10[bilirubin, μmol/L])−(0.085×albumin, g/L).
Results: The median overall survival (mOS) was 0.19 months in ALBI grade 3 (95% CI: 0.10–0.28) and 1.54 months in ALBI grade 2 (95% CI: 0.19–2.89), with a statistically significant difference (p<0.01). Univariate analysis identified NSCLC histology, ALBI grade 3, and chemotherapy during hepatic failure as significant predictors of overall survival. In multivariate analysis, chemotherapy (HR: 0.11, p<0.001) and ALBI grade 3 (HR: 2.31, p=0.008) remained independent prognostic factors.
Conclusion: ALBI score is a useful prognostic marker for survival after liver failure, with ALBI grade 3 indicating worse outcomes. It may aid in risk stratification and clinical decision-making in this high-risk group.

Keywords

ALBI, albumin, bilirubin, lung cancer

References

• Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10. 3322/caac.21834
• Ceriman Krstic V, Samardzic N, Gajic M, et al. Treatment options for patients with non-small cell lung cancer and liver metastases. Curr Issues Mol Biol. 2024;46(12):13443-13455. doi:10.3390/cimb46120802
• Riihimaki M, Hemminki A, Fallah M, et al. Metastatic sites and survival in lung cancer. Lung Cancer. 2014;86(1):78-84. doi:10.1016/j.lungcan. 2014.07.020
• Waninger JJ, Ma VT, Chopra Z, Pearson AN, Green MD. Evaluation of the prognostic role of liver metastases on patient outcomes: systematic review and meta-analysis. Cancer J. 2023;29(5):279-284. doi:10.1097/PPO.0000000000000683
• Toyoda H, Johnson PJ. The ALBI score: from liver function in patients with HCC to a general measure of liver function. JHEP Rep. 2022;4(10): 100557. doi:10.1016/j.jhepr.2022.100557
• Jiang J, Li H, Chen L, Qiu X. Prognostic value of albumin-bilirubin grade in lung cancer: a meta-analysis. J Cardiothorac Surg. 2024;19(1):685. doi: 10.1186/s13019-024-03311-8
• Sun L, Yin H, Liu M, et al. Impaired albumin function: a novel potential indicator for liver function damage? Ann Med. 2019;51(7-8):333-344. doi: 10.1080/07853890.2019.1693056
• Hamoud AR, Weaver L, Stec DE, Hinds TD, Jr. Bilirubin in the liver-gut signaling axis. Trends Endocrinol Metab. 2018;29(3):140-150. doi:10. 1016/j.tem.2018.01.002
• 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. 2015;33(6):550-558. doi: 10.1200/JCO.2014.57.9151
• Diao YH, Shu XP, Tan C, Wang LJ, Cheng Y. Preoperative albumin-bilirubin score predicts short-term outcomes and long-term prognosis in colorectal cancer patients undergoing radical surgery. World J Gastrointest Surg. 2024;16(7):2096. doi:10.4240/wjgs.v16.i7.2096
• Chen L, Tan C, Li Q, et al. Assessment of the albumin-bilirubin score in breast cancer patients with liver metastasis after surgery. Heliyon. 2023; 9(11):e21772. doi:10.1016/j.heliyon.2023.e21772
• Zhang L, Zhang X, Wu B, et al. Prognostic value of albumin-bilirubin score in pancreatic cancer patients after pancreatoduodenectomy with liver metastasis following radiofrequency ablation. Pathol Oncol Res. 2023;29:1611175. doi:10.3389/pore.2023.1611175
• Zhang TN, Yin RH, Wang LW. The prognostic and predictive value of the albumin-bilirubin score in advanced pancreatic cancer. Medicine (Baltimore). 2020;99(28):e20654. doi:10.1097/MD.0000000000020654
• Shi X, Zhang S, Bao B, Cong H, Lu X, Shi A. Albumin-bilirubin score: a promising predictor of postoperative distant metastasis in patients with colorectal cancer. Biomark Med. 2025;19(3):73-79. doi:10.1080/17520363. 2025.2455928
• Koren G, Beatty K, Seto A, Einarson TR, Lishner M. The effects of impaired liver function on the elimination of antineoplastic agents. Ann Pharmacother. 1992;26(3):363-371. doi:10.1177/106002809202600311
• Kinoshita F, Yamashita T, Oku Y, et al. Prognostic impact of albumin-bilirubin (ALBI) grade on non-small lung cell carcinoma: a propensity-score matched analysis. Anticancer Res. 2021;41(3):1621-1628. doi:10. 21873/anticanres.14924
• Takada K, Takamori S, Shimokawa M, et al. Assessment of the albumin-bilirubin grade as a prognostic factor in patients with non-small-cell lung cancer receiving anti-PD-1-based therapy. ESMO Open. 2022;7(1): 100348. doi:10.1016/j.esmoop.2021.100348
• Matsukane R, Watanabe H, Hata K, et al. Prognostic significance of pre-treatment ALBI grade in advanced non-small cell lung cancer receiving immune checkpoint therapy. Sci Rep. 2021;11(1):15057. doi:10.1038/s41598-021-94336-9
• Shi XR, Xu XY, Zhang GL, Jiang JY, Cao DD. The prognostic role of albumin-bilirubin grade in patients with advanced non-small cell lung cancer treated with immune checkpoint inhibitors. Eur Rev Med Pharmacol Sci. 2022;26(20):7687-7694. doi:10.26355/eurrev_202210_ 30045