The albumin-bilirubin (ALBI) grade as a significant prognostic factor in colorectal cancer patients with liver metastases



Albumin-bilirubin grade, Colorectal cancer, Liver metastasis, Prognostic factor


Aim: Colorectal cancer is one of the most common cancers and liver metastases are frequent during its course. Albumin-bilirubin (ALBI) score/grade was shown to predict survival in hepatocellular carcinoma. We aimed to assess the prognostic value of the ALBI score/grade in colorectal cancer patients with liver metastases.

Methods: Medical records of patients with colorectal cancer and synchronous or metachronous liver metastases were reviewed. Serum albumin, total bilirubin, lactate dehydrogenase, carcinoembryogenic antigen and neutrophile-to-lymphocyte ratio at the time of first liver metastasis were determined. ALBI score was calculated from serum albumin and bilirubin and was graded. Multivariate regression models were used to evaluate prognostic factors.

Results: The study included 223 patients. Median overall survival was 23.9, 16.0 and 4.0 months for ALBI grades 1, 2 and 3, respectively (P<0.001). In the first multivariate model, serum albumin was an independent prognostic factor (Hazard ratio=1.97, P=0.001) but total bilirubin was not (Hazard ratio=1.43, P=0.17). In the second multivariate analysis, ALBI grade was a significant predictor of overall survival (Hazard ratio=1.54, P=0.02 for ALBI grade 2 and Hazard ratio=3.85, P<0.001 for ALBI grade 3).

Conclusion: ALBI grade may be a valuable prognostic method to estimate the mortality of patients with colorectal cancer and liver metastases.


Download data is not yet available.


Manfredi S, Lepage C, Hatem C. Epidemiology and management of liver metastases from colorectal cancer. Ann Surg. 2006;244(2):254-9.

Van de Velde C. Treatment of liver metastases of colorectal cancer. Ann Oncol. 2005;16(Supplement 2):144-9.

De Divitiis C, Nasti G, Montano M, Fisichella R, Iaffaioli RV, Berretta M. Prognostic and predictive response factors in colorectal cancer patients: Between hope and reality. World J Gastroenterol. 2014;20(41):15049-59.

Chen B, Lin S. Albumin-bilirubin (ALBI) score at admission predicts possible outcomes in patients with acute-on-chronic liver failure. Medicine. 2017;96:24(e7142).

Zou D, Qi X, Zhu C. Albumin-bilirubin score for predicting the in-hospital mortality of acute upper gastrointestinal bleeding in liver cirrhosis: A retrospective study. Turk J Gastroenterol. 2016;27:180-6.

Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, et al. Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach—The ALBI Grade. J Clin Oncol. 2015;33:550-8.

Hiraoka A, Kumada T, Kudo M, Hirooka M, Tsuji K, Itobayashi E, et al. Albumin-bilirubin (ALBI) grade as part of the evidence-based clinical practice guideline for HCC of the Japan Society of Hepatology: A comparison with the Liver Damage and Child-Pugh Classifications. Liver Cancer. 2017;6:204-15.

Ho C, Chiang C, Lee F. Comparison of platelet-albumin-bilirubin (PALBI), albumin-bilirubin (ALBI), and child-pugh (CP) score for predicting of survival in advanced HCC patients receiving radiotherapy (RT). Oncotarget. 2018;9(48):28818-29.

Hansmann J, Evers MJ, Bui JT, Lokken RP, Lipnik AJ, Gaba RC, et al. Albumin-bilirubin and platelet-albumin-bilirubin grades accurately predict overall survival in high-risk patients undergoing conventional transarterial chemoembolization for hepatocellular carcinoma. J Vasc Interv Radiol. 2017;28:1224-31.

Ho S, Liu P, Hsu C, Chiou Y, Su C, Lee Y, et al. Prognostic performance of ten liver function models in patients with hepatocellular carcinoma undergoing radiofrequency ablation. Sci Rep. 2018;8:843.

Díaz R, Aparicio J, Gironés R, Molina J, Palomar L, Segura A, et al. Analysis of prognostic factors and applicability of Köhne’s prognostic groups in patients with metastatic colorectal cancer treated with first-line irinotecan or oxaliplatin-based chemotherapy. Clin Colorectal Cancer. 2005;5:197-202.

Sanoff HK, Sargent DJ, Campbell ME, Morton RF, Fuchs CS, Ramanathan RK, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26:5721-27.

Chibaudel B, Bonnetain F, Tournigand C. Simplified prognostic model in patients with oxaliplatin-based or irinotecan-based first-line chemotherapy for metastatic colorectal cancer: A GERCOR study. The Oncologist. 2011;16:1228-38.

Li G, Wang Z, Xu J, Wu H, Cai S, He Y. The prognostic value of lactate dehydrogenase levels in colorectal cancer: a meta-analysis. BMC Cancer. 2016;16:249.

Passardi A, Scarpi E, Tamberi S, Cavanna L, Tassinari D, Fontana A, et al. Impact of pre-treatment lactate dehydrogenase levels on prognosis and bevacizumab efficacy in patients with metastatic colorectal cancer. PLoS ONE. 2015;10(8):e0134732.

Heys SD, Walker LG, Deehan DJ, Eremin OE. Serum albumin: a prognostic indicator in patients with colorectal cancer. J R Coll Surg Edinb. 1998;43(3):163-8.

Lai CC, You JF, Yeh CY, Chen JS, Tang R, Wang JY, et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis. 2011;26:473-81.

Chandrasinghe PC, Ediriweera DS, Kumarage SK, Deen KI. Pre-operative hypoalbuminaemia predicts poor overall survival in rectal cancer: a retrospective cohort analysis. BMC Clin Pathol. 2013;13:12.

Zhang Q, Ma X, Xu Q, Qin J, Wang Y, Liu Q, et al. Nomograms incorporated serum direct bilirubin level for predicting prognosis in stages II and III colorectal cancer after radical resection. Oncotarget. 2017;8(41):71138-46.

Yang L, Ge LY, Yu T, Liang Y, Yin Y, Chen H. The prognostic impact of serum bilirubin in stage IV colorectal cancer patients. J Clin Lab Anal. 2018;32(2).

Hsu CW, King TM, Chang MC, Wang CH. Factors that influence survival in colorectal cancer with synchronous distant metastasis. J Chin Med Assoc. 2012;75:370-5.

Dell’Aquila E, Cremolini C, Zeppola T, Lonardi S, Bergamo F, Masi G, et al. Prognostic and predictive role of neutrophil/lymphocytes ratio in metastatic colorectal cancer: a retrospective analysis of the TRIBE study by GONO. Ann Oncol. 2018;29:924-30.

Jiang Z, Wang X, Tan X, Fan Z. Effect of age on survival outcome in operated and non-operated patients with colon cancer: A population-based study. PLoS ONE. 2016;11(1):e0147383.

Fu J, Yang J, Tan Y, Jiang M, Wen F, Huang Y, et al. Young patients (≤35 years old) with colorectal cancer have worse outcomes due to more advanced disease. Medicine. 2014;93(23):e135.






Research Article

How to Cite

Demircan N, Köstek O, Gökyer A, Küçükarda A, Hacıoğlu M, Erdoğan B, Uzunoğlu S, Çiçin İrfan. The albumin-bilirubin (ALBI) grade as a significant prognostic factor in colorectal cancer patients with liver metastases. J Surg Med [Internet]. 2019 Dec. 3 [cited 2024 Jun. 19];3(12):841-4. Available from: