Prognostic utility of albumin-bilirubin grade for short- and long-term outcomes following hepatic resection for intrahepatic cholangiocarcinoma: A multi-institutional analysis of 706 patients.

Journal Article (Multicenter Study;Journal Article)


The objective of the current study was to define the impact of albumin-bilirubin (ALBI) grade on short- as well as long-term outcomes among patients with intrahepatic cholangiocarcinoma (ICC).


Patients who underwent hepatectomy for ICC between 1990 and 2016 were identified using an international multi-institutional database. Clinicopathologic factors including ALBI score were assessed using bivariate and multivariable analyses, as well as standard survival analyses.


Among 706 patients, 453 (64.2%) patients had ALBI grade 1, 231 (32.7%) ALBI grade 2, and 22 (3.1%) had ALBI grade 3. After adjusting for all competing factors, patients with ALBI grade 2/3 had higher odds of a prolonged length-of-stay (>10 days, odds ratio [OR] = 2.37, 95% confidence interval [CI]:1.47-3.80), perioperative transfusion (OR = 2.15, 95% CI:1.45-3.18) and 90-day mortality (OR = 2.50, 95% CI:1.16-5.38). Median and 5-year overall survival (OS) for the entire cohort was 41.5 months (IQR:15.7-107.8) and 39.8%, respectively. Of note, median OS incrementally worsened with increased ALBI grade: grade 1, 49.6 months (IQR:18.3-NR) vs grade 2, 29.6 months (IQR:12.6-98.4) vs grade 3, 16.9 months (IQR:6.5-32.4; P < 0.001). On multivariable analysis, higher ALBI grade remained associated with higher hazards of death (grade 2/3: hazard ratio = 1.36, 95% CI:1.04-1.78).


The ALBI score was associated with both short- and long-term outcomes following resection for ICC and could prove a useful surrogate marker to identify patients at risk for adverse outcomes.

Full Text

Duke Authors

Cited Authors

  • Tsilimigras, DI; Hyer, JM; Moris, D; Sahara, K; Bagante, F; Guglielmi, A; Aldrighetti, L; Alexandrescu, S; Marques, HP; Shen, F; Koerkamp, BG; Endo, I; Pawlik, TM; other members of the International Intrahepatic Cholangiocarcinoma Study Group,

Published Date

  • August 2019

Published In

Volume / Issue

  • 120 / 2

Start / End Page

  • 206 - 213

PubMed ID

  • 31025380

Electronic International Standard Serial Number (EISSN)

  • 1096-9098

International Standard Serial Number (ISSN)

  • 0022-4790

Digital Object Identifier (DOI)

  • 10.1002/jso.25486


  • eng