Initial albumin-bilirubin grade as a prognostic indicator of pancreatic cancer with liver metastasis

Abstract

Objective: Pancreatic cancer (PCa) is the fourth leading cause of cancer-related deaths. Thus, there is a need for prognostic in-dicators that can aid in disease classification and subsequent selection of appropriate treatment options. Albumin-bilirubin (ALBI) grade, which is calculated using a logarithmic formula, is indicative of liver function. The present study evaluated the prognostic performance of the initial ALBI grade for metastatic PCa in patients receiving first-line chemotherapy. Material and Methods: In this retrospective study, the medical records of 114 patients with de novo liver metastatic PCa and unresectable liver metastasis were evaluated. The ALBI grade was calculated using the formula (log10 bilirubin × 0.66) + (albumin ×-0.085), and based on the grade, patients were divided into 3 groups, namely, ALBI Grade 1, ≤-2.60; ALBI Grade 2, between −2.60 and-1.39; and ALBI Grade 3, ≥-1.39. Results: Median progression-free survival (PFS) was 13 months [95% confidence interval (CI), 7.3-18.6]. The estimated PFS was 16 months for ALBI Grade 1 (95% CI, 13.0-20.4), 8 months for ALBI Grade 2 (95% CI, 7.5-9.9), and 5 months for ALBI Grade 3 (95% CI, 4.3-5.6). Median overall survival (OS) was 11 months (95% CI, 9.0-12.9). The estimated OS was 18 months for ALBI Grade 1 (95% CI, 14.4-21.5), 9 months for ALBI Grade 2 (95% CI, 7.8-10.1), and 6 months for ALBI Grade 3 (95% CI, 4.1-7.8; p<0.001). Conclusion: The initial ALBI grade demonstrated outstanding performance as an independent prognostic factor in PCa patients with liver metastasis.