Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy

Table 1 Clinical and surgical characteristics of patients with gastric cancer according albumin-bilirubin risk groups, n (%)

Variables	Low-ALBI group (< -2.82), n = 211	High-ALBI group (≥ -2.82), n = 150	P value
Sex			0.712
Female	72 (34.1)	54 (36.0)
Male	139 (65.9)	96 (64.0)
Age (yr)			0.005
mean (SD)	62.0 (12.0)	65.6 (12.2)
BMI (kg/cm²)			0.856
mean (SD)	25 (4.5)	25.2 (16.5)
Hemoglobin (g/dL)			< 0.001
mean (SD)	12.7 (2.1)	11.1 (2.1)
Albumin (g/dL)			< 0.001
mean (SD)	4.3 (0.3)	3.5 (0.5)
Bilirubin (mg/dL)			0.072
mean (SD)	0.41 (0.22)	0.47 (0.33)
Neutrophil to lymphocyte ratio			0.092
mean (SD)	2.48 (2.29)	2.91 (2.56)
American Society of Anesthesiologists			0.001
I/II	178 (84.4)	105 (70.0)
III/IV	33 (15.6)	45 (30.0)
Charlson–Deyo Comorbidity Index1			0.344
0	141 (66.8)	93 (62.0)
≥ 1	70 (33.2)	57 (38.0)
Type of gastrectomy			0.562
Subtotal	126 (59.7)	85 (56.7)
Total	85 (40.3)	65 (43.3)
Lymphadenectomy			0.003
D1	34 (16.1)	44 (29.3)
D2	177 (83.9)	106 (70.7)
Preoperative chemotherapy			0.477
No	175 (82.9)	120 (80)
Yes	36 (17.1)	30 (20)

¹Considered without including age and cancer as comorbidity.

P values in bold are statistically significant. BMI: Body mass index; ALBI: Albumin-bilirubin.

Table 2 Pathological characteristics of patients with gastric cancer according albumin-bilirubin groups, n (%)

Variables	Low-ALBI group (< -2.82), n = 211	High-ALBI group (≥ -2.82), n = 150	P value
Lauren type			0.367
Intestinal	124 (58.8)	81 (54.0)
Diffuse/mixed	87 (41.2)	69 (46.0)
Histological differentiation			0.993
Well/moderately differentiated	107 (59.7)	76 (50.7)
Poorly differentiated	104 (49.3)	74 (49.3)
Lymphatic invasion			0.132
No	121 (57.3)	74 (49.3)
Yes	90 (42.7)	76 (50.7)
Venous invasion			0.196
No	150 (71.1)	97 (64.7)
Yes	61 (28.9)	53 (35.3)
Perineural invasion			0.743
No	112 (53.1)	77 (51.3)
Yes	99 (46.9)	73 (48.7)
T status			0.105
pT1/T2	91 (43.1)	52 (34.7)
pT3/T4	120 (56.9)	98 (65.3)
No of dissected lymph nodes			0.543
mean (SD)	40.9 (17.7)	39.8 (17.2)
pN status			0.239
pN0	99 (46.9)	61 (40.7)
pN+	112 (53.1)	89 (59.3)
pTNM			0.222
I/II	122 (57.8)	77 (51.3)
III	89 (42.2)	73 (48.7)

ALBI: Albumin-bilirubin; pN: Presence of lymph node metastasis; pTNM: Pathologic.

Table 3 Postoperative and surgical outcomes of patients with gastric cancer according albumin-bilirubin groups, n (%)

Variables	Low-ALBI group (< -2.82), n = 211	High-ALBI group (≥ -2.82), n = 150	P value
Length of hospital stay (d)			0.673
Median (IQR)	9 (6.0-13.3)	10 (7.0-13.8)
Postoperative complications (Clavien)			0.029
Non/minor POC (I-II)	183 (86.7)	117 (78)
Major POC (III-IV)	28 (13.3)	33 (22)
Postoperative chemotherapy			0.917
No	117 (55.5)	84 (56)
Yes	94 (44.5)	66 (44)
Chemotherapy-all (pre or postoperative)			0.766
No	99 (46.9)	68 (45.3)
Yes	112 (53.1)	82 (54.7)
30-d motality			0.023
No	206 (97.6)	138 (92.6)
Yes	5 (2.4)	11 (7.4)
90-d motality			0.030
No	198 (94.7)	130 (88.4)
Yes	11 (5.3)	17 (11.6)

P values in bold are statistically significant. IQR: Interquartile range; ALBI: Albumin-bilirubin; POC: Postoperative complications.

Table 4 Univariate and multivariate analysis for disease-free survival

Disease-free survival	Univariate			Multivariate
Variables	HR	95%CI	P value	HR	95%CI	P value
Male (vs female)	1.15	0.81-1.61	0.438	-	-	-
Age > 65 yr (vs < 65 yr)	1.18	0.86-1.62	0.312	-	-	-
Charlson > 1 (vs 0)	1.48	1.07-2.04	0.019	1.39	0.94-2.06	0.102
ASA III/IV (vs ASA I/II)	1.84	1.29-2.64	0.001	1.43	0.93-2.21	0.106
Total gastrectomy (vs distal)	1.43	1.04-1.97	0.030	1.43	1.03-1.98	0.031
Diffuse/mixed (vs others)	1.21	0.87-1.67	0.255	-	-	-
pT3/T4 (vs pT1/T2)	2.57	1.76-3.76	< 0.001	2.03	1.33-3.12	0.001
pN+ (vs pN0)	2.26	1.60-3.19	< 0.001	1.54	1.04-2.27	0.030
non-CMT (vs CMT)	1.15	0.83-1.58	0.399	-	-	-
Low-ALBI (vs High-ALBI)	2.09	1.51-2.88	< 0.001	1.83	1.32-2.53	< 0.001

P values in bold are statistically significant. 95%CI: 95% confidence interval; HR: Hazard ratio; ASA: American Society of Anesthesiologists; ALBI: Albumin-bilirubin; pN: Presence of lymph node metastasis; CMT: Chemotherapy.

Table 5 Univariate and multivariate analysis for overall survival

Overall survival	Univariate			Multivariate
Variables	HR	95%CI	P value	HR	95%CI	P value
Male (vs female)	1.20	0.85-1.71	0.306	-	-	-
Age > 65 yr (vs < 65 yr)	1.28	0.94-1.79	0.137	-	-	-
Charlson > 1 (vs 0)	1.42	1.02-1.98	0.041	1.25	0.83-1.89	0.282
ASA III/IV (vs ASA I/II)	1.94	1.35-2.80	< 0.001	1.60	1.02-2.52	0.041
Total gastrectomy (vs distal)	1.50	1.08-2.08	0.016	1.56	1.12-2.18	0.009
Diffuse/mixed (vs others)	1.29	0.93-1.79	0.133	-	-	-
pT3/T4 (vs pT1/T2)	2.44	1.65-3.61	< 0.001	1.87	1.20-2.91	0.006
pN+ (vs pN0)	2.24	1.57-3.20	< 0.001	1.58	1.06-2.37	0.026
non-CMT (vs CMT)	1.18	0.85-1.64	0.327	-	-	-
Low-ALBI (vs High-ALBI)	1.97	1.41-2.74	< 0.001	1.68	1.20-2.35	0.003

P values in bold are statistically significant. 95%CI: 95% confidence interval; HR: Hazard ratio; ASA: American Society of Anesthesiologists; ALBI: Albumin-bilirubin; pN: Presence of lymph node metastasis; CMT: Chemotherapy.