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Abstract：
Hepatocellular carcinoma (HCC) usually arises in the context of a chronically damaged liver. Liver functional estimation is of paramount importance in clinical decision making. The Child-Pugh score (CPS) can be used to categorise patients into 3 classes (A to C) based on the severity of liver functional impairment according to 5 parameters (albumin, bilirubin, prothrombin time, presence of ascites and hepatic encephalopathy). The albumin-bilirubin (ALBI) grade has emerged as an alternative, reproducible and objective measure of liver functional reserve in patients with HCC, defining worsening liver impairment across 3 grades (I to III). The ALBI score can identify different subgroups of patients with different prognoses across the diverse Barcelona Clinic Liver Cancer stages and CP classes, making it an appealing clinical predictor. In patients treated with potentially curative approaches (resection, transplantation, radiofrequency ablation, microwave ablation), ALBI grade has been shown to correlate with survival, tumour relapse, and post-hepatectomy liver failure. ALBI grade also predicts survival, toxicity and post-procedural liver failure in patients treated with transarterial chemoembolisation, radioembolisation, external beam radiotherapy as well as multi-kinase inhibitors (sorafenib, lenvatinib, cabozantinib, regorafenib) and immune checkpoint inhibitor therapy. In this review, we summarise the body of evidence surrounding the role of ALBI grade as a biomarker capable of optimising patient selection and therapeutic sequencing in HCC.
摘要：
肝细胞癌（HCC）通常发生在慢性受损的肝脏的背景下。肝功能评估在临床决策中至关重要。Child-Pugh评分（CPS）可用于根据5个参数（白蛋白，胆红素,凝血酶原时间,存在腹水和肝性脑病）。白蛋白-胆红素（ALBI）等级已经成为一种替代方法，肝细胞癌患者肝功能储备的可重复和客观测量，定义3个等级（I至III）的肝功能损害恶化。ALBI评分可以识别不同巴塞罗那临床肝癌分期和CP类别的不同预后患者的不同亚组。使其成为一个有吸引力的临床预测指标。在接受潜在治愈方法治疗的患者中（切除，移植,射频消融,微波消融)，ALBI等级已被证明与生存率相关，肿瘤复发，和肝切除术后肝功能衰竭。ALBI等级也可以预测生存率，经动脉化疗栓塞治疗的患者的毒性和术后肝功能衰竭，放射栓塞,外束放疗以及多激酶抑制剂（索拉非尼，lenvatinib,卡博替尼,瑞戈非尼)和免疫检查点抑制剂治疗。在这次审查中,我们总结了关于ALBI分级作为能够优化HCC患者选择和治疗测序的生物标志物的作用的大量证据。
