Assessment of the albumin-bilirubin grade as a prognostic factor in patients with non-small-cell lung cancer receiving anti-PD-1-based therapy

• Published in: ESMO open 2022-02, Vol.7 (1), p.100348-100348, Article 100348
• Main Authors: Takada, K., Takamori, S., Shimokawa, M., Toyokawa, G., Shimamatsu, S., Hirai, F., Tagawa, T., Okamoto, T., Hamatake, M., Tsuchiya-Kawano, Y., Otsubo, K., Inoue, K., Yoneshima, Y., Tanaka, K., Okamoto, I., Nakanishi, Y., Mori, M.
• Format: Article
• Language: English
• Subjects: albumin-bilirubin grade; Albumins - analysis; Bilirubin - analysis; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - drug therapy; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - drug therapy; Neoplasm Recurrence, Local; nivolumab; non-small-cell lung cancer; Original Research; pembrolizumab; Prognosis; prognostic factor; Programmed Cell Death 1 Receptor - antagonists & inhibitors; Prospective Studies; Retrospective Studies
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2021.100348

The albumin-bilirubin (ALBI) grade is a novel indicator of the liver function. Some studies showed that the ALBI grade was a prognostic and predictive biomarker for the efficacy of chemotherapy in cancer patients. The association between the ALBI grade and outcomes in patients with non-small-cell lung cancer (NSCLC) treated with cancer immunotherapy, however, is poorly understood. We retrospectively enrolled 452 patients with advanced or recurrent NSCLC who received anti-programmed cell death protein 1 (PD-1)-based therapy between 2016 and 2019 at three medical centers in Japan. The ALBI score was calculated from albumin and bilirubin measured at the time of treatment initiation and was stratified into three categories, ALBI grade 1-3, with reference to previous reports. We examined the clinical impact of the ALBI grade on the outcomes of NSCLC patients receiving anti-PD-1-based therapy using Kaplan–Meier survival curve analysis with log-rank test and Cox proportional hazards regression analysis. The classifications of the 452 patients were as follows: grade 1, n = 158 (35.0%); grade 2, n = 271 (60.0%); and grade 3, n = 23 (5.0%). Kaplan–Meier survival curve analysis showed that the ALBI grade was significantly associated with progression-free survival and overall survival. Moreover, Cox regression analysis revealed that the ALBI grade was an independent prognostic factor for progression-free survival and overall survival. The ALBI grade was an independent prognostic factor for survival in patients with advanced or recurrent NSCLC who receive anti-PD-1-based therapy. These findings should be validated in a prospective study with a larger sample size. •ALBI grade is calculated from albumin and bilirubin.•We evaluated the impact of ALBI grade on survival in NSCLC patients receiving immune checkpoint inhibitors.•ALBI grade was an independent prognostic factor for progression-free survival (PFS) and overall survival (OS).•ALBI grade effectively stratified PFS and OS in patients with performance status 1-3.•ALBI grade was significantly associated with PFS and OS, regardless of programmed death ligand-1.