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Gastrointestinal cancer
Clinical Significance of Combining Preoperative and Postoperative Albumin-Bilirubin Score in Colorectal Cancer
Doyoun Kim, Jae-Hoon Lee, Eun-Suk Cho, Su-Jin Shin, Hye Sun Lee, Hwa-Hee Koh, Kang Young Lee, Jeonghyun Kang
Cancer Res Treat. 2023;55(4):1261-1269.   Published online April 17, 2023
DOI: https://doi.org/10.4143/crt.2022.1444
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Albumin-bilirubin (ALBI) score is a well-known prognostic factor for various diseases, including colorectal cancer (CRC). However, little is known about the significance of postoperative ALBI score changes in patients with CRC.
Materials and Methods
A total of 723 patients who underwent surgery were enrolled. Preoperative ALBI (ALBI-pre) and postoperative ALBI (ALBI-post) scores were divided into low and high score groups. ALBI-trend was defined as a combination of four groups comprising the low and high ALBI-pre and ALBI-post score groups. Kaplan-Meier survival curves were used to compare the overall survival (OS) between the different ALBI groups. The Cox proportional hazards model was used to examine the independent relevant factors of OS. Stratification performance was compared between the different ALBI groupings using Harrell’s concordance index (C-index).
Results
ALBI-pre, ALBI-post, and ALBI-trend score groups were significant prognostic factors of OS in the univariable analysis. However, multivariable analysis showed that ALBI-trend was an independent prognostic factor while ALBI-pre and ALBI-post were not. The C-index of ALBI-trend (0.622; 95% confidence interval [CI], 0.587 to 0.655) was higher than that of ALBI-pre (0.589; 95% CI, 0.557 to 0.621; bootstrap mean difference, 0.033; 95% CI, 0.013 to 0.057) and ALBI-post (0.575; 95% CI, 0.545 to 0.605; bootstrap mean difference, 0.047; 95% CI, 0.024 to 0.074).
Conclusion
Combining ALBI-pre and ALBI-post scores is an independent prognostic factor of OS and shows superior predictive power compared to ALBI-pre or ALBI-post alone in patients with CRC.

Citations

Citations to this article as recorded by  
  • Prognostic value of functional MRI and liver function synergy in hepatocellular carcinoma patients receiving combined locoregional-systemic therapy: A multicenter scoring model
    Langlang Tang, Kaiqian Que, Yanfen Lan, Yimin Li, Bin Wang, Zhuting Fang
    European Journal of Radiology.2026; 196: 112705.     CrossRef
  • Associations of bilirubin, albumin, and the ALBI index with gastric cancer risk: a smoking-stratified prospective cohort study in men
    Jong Won Shin, Ji-Won Lee, Nguyen Thien Minh, Sun Ha Jee
    BMC Gastroenterology.2026;[Epub]     CrossRef
  • Comparing laboratory toxicity of selective intra-arterial radionuclide therapy for primary and metastatic liver tumors: resin versus glass microspheres
    Başak Soydaş-Turan, M. Fani Bozkurt, Gonca Eldem, Bora Peynircioglu, Omer Ugur, Bilge Volkan-Salanci
    Annals of Nuclear Medicine.2025; 39(4): 373.     CrossRef
  • Improvement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Postsurgical Portal Vein Stenosis
    Naoya Kinota, Daisuke Abo, Ryo Morita, Koji Yamasaki, Takaaki Fujii, Daisuke Kato, Tasuku Kimura, Yusuke Sakuhara, Kazufumi Okada, Isao Yokota, Tatsuya Orimo, Tatsuhiko Kakisaka, Toru Nakamura, Satoshi Hirano, Kazuyuki Minowa, Kohsuke Kudo
    Journal of Vascular and Interventional Radiology.2025; 36(4): 616.     CrossRef
  • Gastrointestinal tumors of the small bowel: prognostic roles of tumor stage and inflammatory markers
    Mehmet Torun, Sevil Özkan, Deniz Kol Özbay, Erkan Özkan
    Anatolian Current Medical Journal.2025; 7(2): 164.     CrossRef
  • Predictive value of preoperative serum cytokeratin 19 fragment antigen 21-1(CYFRA 21-1) in surgical resection for colorectal cancer: A retrospective study
    Shuyuan Gu, Shihui Chen, Yuan Chai, Chao Qu, Xuejun Sun, Junhui Yu
    Current Problems in Surgery.2025; 69: 101791.     CrossRef
  • Sex-Specific Associations of Total Bilirubin, ALBI, and PALBI with Lung Cancer Risk: Interactions with Smoking and Alcohol
    Jong Won Shin, Nguyen Thien Minh, Sun Ha Jee
    Healthcare.2025; 13(11): 1321.     CrossRef
  • Bilirubin Metabolism and Thyroid Cancer: Insights from ALBI and PALBI Indices
    Jong Won Shin, Jae Woong Sull, Nguyen Thien Minh, Sun Ha Jee
    Biomolecules.2025; 15(7): 1042.     CrossRef
  • Hemoglobin-Albumin-Lymphocyte-Platelet Score as an Integrative Biomarker for Prognosis and Sarcopenia in Colorectal Cancer
    Hailun Xie, Lishuang Wei, Shuangyi Tang, Jialiang Gan
    Journal of Inflammation Research.2025; Volume 18: 14709.     CrossRef
  • The association between the albumin-bilirubin score and postoperative delirium and prognosis in cardiac surgery patients: a retrospective dual-center cohort study using MIMIC-IV and eICU databases
    Na Zhu, Xiejia Weng, Xinxin Wang, Huiyang Cai
    BMC Surgery.2025;[Epub]     CrossRef
  • The prognostic value of preoperative serum liver function-related indicators in colorectal cancer
    Lang Wang, Jinshan Liu, Can Tan, Yuhang Diao, Lijuan Wang, Youyun Shi, Xinpeng Shu, Yong Cheng
    Medicine.2025; 104(51): e46047.     CrossRef
  • Research Progress of Albumin-Based Composite Markers in Prognosis Evaluation of Patients with Colorectal Cancer
    Xu Lei, Jie Yu
    Journal of Biosciences and Medicines.2025; 13(09): 24.     CrossRef
  • Assessment of the albumin-bilirubin score in breast cancer patients with liver metastasis after surgery
    Li Chen, Chunlei Tan, Qingwen Li, Zhibo Ma, Meng Wu, Xiaosheng Tan, Tiangen Wu, Jinwen Liu, Jing Wang
    Heliyon.2023; 9(11): e21772.     CrossRef
  • 6,718 View
  • 195 Download
  • 11 Web of Science
  • 13 Crossref
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Association of Body Mass Index with Survival in Asian Patients with Colorectal Cancer
Sangwon Lee, Dong Hee Lee, Jae-Hoon Lee, Su-Jin Shin, Hye Sun Lee, Eun Jung Park, Seung Hyuk Baik, Kang Young Lee, Jeonghyun Kang
Cancer Res Treat. 2022;54(3):860-872.   Published online October 15, 2021
DOI: https://doi.org/10.4143/crt.2021.656
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The clinical significance of body mass index (BMI) on long-term outcomes has not been extensively investigated in Asian patients with colorectal cancer (CRC). This study aims to describe the association between BMI and survival, plus providing BMI cut-off value for predicting prognosis in CRC patients.
Materials and Methods
A total of 1,182 patients who had undergone surgery for stage I-III CRC from June 2004 to February 2014 were included. BMI was categorized into four groups based on the recommendation for Asian ethnicity. The optimal BMI cut-off value was determined to maximize overall survival (OS) difference.
Results
In multivariable analysis, underweight BMI was significantly associated with poor OS (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.55 to 3.71; p < 0.001) and obese BMI was associated with better OS (HR, 0.72; 95% CI, 0.53 to 0.97; p=0.036) compared with the normal BMI. Overweight and obese BMI were associated with better recurrence-free survival (HR, 0.64; 95% CI, 0.42 to 0.99; p=0.046 and HR, 0.58; 95% CI, 0.38 to 0.89; p=0.014, respectively) compared with the normal BMI group. BMI cutoff value was 20.44 kg/m2. Adding the BMI cutoff value to cancer staging could increase discriminatory performance in terms of integrated area under the curve and Harrell’s concordance index.
Conclusion
Compared to normal BMI, underweight BMI was associated with poor survival whereas obese BMI was associated with better survival. BMI cut-off value of 20.44 kg/m2 is a useful discriminator in Asian patients with CRC.

Citations

Citations to this article as recorded by  
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    BMC Geriatrics.2026;[Epub]     CrossRef
  • Survival Outcomes of Patients With Colorectal Cancer After Primary Surgery: A Population‐Based Study in Hainan, China
    Le Du, Luyao Sun, Dongsheng Ge, Mingfa Wang, Benguo Yu, Wenjun Yang, Wenlong Yang, Ruyuan An, Junchao Li, Jike Zhu, Zaipan Wang, Ning Liu, Wenting Cao
    Cancer Medicine.2026;[Epub]     CrossRef
  • Comment on “Dense Tumor‐Infiltrating Lymphocytes (TILs) in Liver Metastasis From Colorectal Cancer Are Related to Improved Overall Survival”
    Fuji Lai, Sheng Li, Zhonglei Shen
    Journal of Surgical Oncology.2025; 131(4): 566.     CrossRef
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    Kirati Kengkla, Surakit Nathisuwan, Warunsuda Sripakdee, Pirun Saelue, Kwanruethai Sengnoo, Aumkhae Sookprasert, Suphat Subongkot
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    Annals of Surgical Treatment and Research.2024; 107(2): 68.     CrossRef
  • Obesity, the Adipose Organ and Cancer in Humans: Association or Causation?
    Elisabetta Trevellin, Silvia Bettini, Anna Pilatone, Roberto Vettor, Gabriella Milan
    Biomedicines.2023; 11(5): 1319.     CrossRef
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    BMC Cancer.2022;[Epub]     CrossRef
  • Preoperative carcinoembryonic antigen to body mass index ratio contributes to prognosis prediction in colorectal cancer
    Jia Xiang, Mengyao Ding, Jixing Lin, Tianhui Xue, Qianwen Ye, Bing Yan
    Oncology Letters.2022;[Epub]     CrossRef
  • 11,402 View
  • 161 Download
  • 12 Web of Science
  • 10 Crossref
Close layer
Machine Learning Model for Predicting Postoperative Survival of Patients with Colorectal Cancer
Mohamed Hosny Osman, Reham Hosny Mohamed, Hossam Mohamed Sarhan, Eun Jung Park, Seung Hyuk Baik, Kang Young Lee, Jeonghyun Kang
Cancer Res Treat. 2022;54(2):517-524.   Published online June 15, 2021
DOI: https://doi.org/10.4143/crt.2021.206
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Machine learning (ML) is a strong candidate for making accurate predictions, as we can use large amount of data with powerful computational algorithms. We developed a ML based model to predict survival of patients with colorectal cancer (CRC) using data from two independent datasets.
Materials and Methods
A total of 364,316 and 1,572 CRC patients were included from the Surveillance, Epidemiology, and End Results (SEER) and a Korean dataset, respectively. As SEER combines data from 18 cancer registries, internal validation was done using 18-Fold-Cross-Validation then external validation was performed by testing the trained model on the Korean dataset. Performance was evaluated using area under the receiver operating characteristic curve (AUROC), sensitivity and positive predictive values.
Results
Clinicopathological characteristics were significantly different between the two datasets and the SEER showed a significant lower 5-year survival rate compared to the Korean dataset (60.1% vs. 75.3%, p < 0.001). The ML-based model using the Light gradient boosting algorithm achieved a better performance in predicting 5-year-survival compared to American Joint Committee on Cancer stage (AUROC, 0.804 vs. 0.736; p < 0.001). The most important features which influenced model performance were age, number of examined lymph nodes, and tumor size. Sensitivity and positive predictive values of predicting 5-year-survival for classes including dead or alive were reported as 68.14%, 77.51% and 49.88%, 88.1% respectively in the validation set. Survival probability can be checked using the web-based survival predictor (http://colorectalcancer.pythonanywhere.com).
Conclusion
ML-based model achieved a much better performance compared to staging in individualized estimation of survival of patients with CRC.

Citations

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    洪铭 崔
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  • 24 Web of Science
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Gastrointestinal Cancer
LASSO-Based Machine Learning Algorithm for Prediction of Lymph Node Metastasis in T1 Colorectal Cancer
Jeonghyun Kang, Yoon Jung Choi, Im-kyung Kim, Hye Sun Lee, Hogeun Kim, Seung Hyuk Baik, Nam Kyu Kim, Kang Young Lee
Cancer Res Treat. 2021;53(3):773-783.   Published online December 29, 2020
DOI: https://doi.org/10.4143/crt.2020.974
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The role of tumor-infiltrating lymphocytes (TILs) in predicting lymph node metastasis (LNM) in patients with T1 colorectal cancer (CRC) remains unclear. Furthermore, clinical utility of a machine learning–based approach has not been widely studied.
Materials and Methods
Immunohistochemistry for TILs against CD3, CD8, and forkhead box P3 in both center and invasive margin of the tumor were performed using surgically resected T1 CRC slides. Three hundred and sixteen patients were enrolled and categorized into training (n=221) and validation (n=95) sets via random sampling. Using clinicopathologic variables including TILs, the least absolute shrinkage and selection operator (LASSO) regression model was applied for variable selection and predictive signature building in the training set. The predictive accuracy of our model and the Japanese criteria were compared using area under the receiver operating characteristic (AUROC), net reclassification improvement (NRI)/integrated discrimination improvement (IDI), and decision curve analysis (DCA) in the validation set.
Results
LNM was detected in 29 (13.1%) and 12 (12.6%) patients in training and validation sets, respectively. Nine variables were selected and used to generate the LASSO model. Its performance was similar in training and validation sets (AUROC, 0.795 vs. 0.765; p=0.747). In the validation set, the LASSO model showed better outcomes in predicting LNM than Japanese criteria, as measured by AUROC (0.765 vs. 0.518, p=0.003) and NRI (0.447, p=0.039)/IDI (0.121, p=0.034). DCA showed positive net benefits in using our model.
Conclusion
Our LASSO model incorporating histopathologic parameters and TILs showed superior performance compared to conventional Japanese criteria in predicting LNM in patients with T1 CRC.

Citations

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Which Patients with Isolated Para-aortic Lymph Node Metastasis Will Truly Benefit from Extended Lymph Node Dissection for Colon Cancer?
Sung Uk Bae, Hyuk Hur, Byung Soh Min, Seung Hyuk Baik, Kang Young Lee, Nam Kyu Kim
Cancer Res Treat. 2018;50(3):712-719.   Published online July 14, 2017
DOI: https://doi.org/10.4143/crt.2017.100
AbstractAbstract PDFPubReaderePub
Purpose
The prognosis of patientswith colon cancer and para-aortic lymph node metastasis (PALNM) is poor. We analyzed the prognostic factors of extramesenteric lymphadenectomy for colon cancer patients with isolated PALNM.
Materials and Methods
We retrospectively reviewed 49 patients with PALNM who underwent curative resection between October 1988 and December 2009.
Results
In univariate analyses, the 5-year overall survival (OS) and disease-free survival (DFS) rates were higher in patients with ≤ 7 positive para-aortic lymph node (PALN) (36.5% and 27.5%) than in those with > 7 PALN (14.3% and 14.3%; p=0.010 and p=0.027, respectively), and preoperative carcinoembryonic antigen (CEA) level > 5 was also correlated with a lower 5-year OS and DFS rate of 21.5% and 11.7% compared with those with CEA ≤ 5 (46.3% and 41.4%; p=0.122 and 0.039, respectively). Multivariate analysis found that the number of positive PALN (hazard ratio [HR], 3.291; 95% confidence interval [CI], 1.309 to 8.275; p=0.011) was an independent prognostic factor for OS and the number of positive PALN (HR, 2.484; 95% CI, 0.993 to 6.211; p=0.052) and preoperative CEA level (HR, 1.953; 95% CI, 0.940 to 4.057; p=0.073) were marginally independent prognostic factors for DFS. According to our prognostic model, the 5-year OS and DFS rate increased to 59.3% and 53.3%, respectively, in patients with ≤ 7 positive PALN and CEA level ≤ 5.
Conclusion
PALN dissection might be beneficial in carefully selected patients with a low CEA level and less extensive PALNM.

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In Vitro Adenosine Triphosphate-Based Chemotherapy Response Assay as a Predictor of Clinical Response to Fluorouracil-Based Adjuvant Chemotherapy in Stage II Colorectal Cancer
Hye Youn Kwon, Im-kyung Kim, Jeonghyun Kang, Seung-Kook Sohn, Kang Young Lee
Cancer Res Treat. 2016;48(3):970-977.   Published online October 22, 2015
DOI: https://doi.org/10.4143/crt.2015.140
AbstractAbstract PDFPubReaderePub
Purpose
We evaluated the usefulness of the in vitro adenosine triphosphate-based chemotherapy response assay (ATP-CRA) for prediction of clinical response to fluorouracil-based adjuvant chemotherapy in stage II colorectal cancer. Materials and Methods Tumor specimens of 86 patients with pathologically confirmed stage II colorectal adenocarcinoma were tested for chemosensitivity to fluorouracil. Chemosensitivity was determined by cell death rate (CDR) of drug-exposed cells, calculated by comparing the intracellular ATP level with that of untreated controls. Results Among the 86 enrolled patients who underwent radical surgery followed by fluorouracilbased adjuvant chemotherapy, recurrence was found in 11 patients (12.7%). The CDR ≥ 20% group was associated with better disease-free survival than the CDR < 20% group (89.4% vs. 70.1%, p=0.027). Multivariate analysis showed that CDR < 20% and T4 stage were poor prognostic factors for disease-free survival after fluorouracil-based adjuvant chemotherapy. Conclusion In stage II colorectal cancer, the in vitro ATP-CRA may be useful in identifying patients likely to benefit from fluorouracil-based adjuvant chemotherapy.

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p16 Hypermethylation and KRAS Mutation Are Independent Predictors of Cetuximab Plus FOLFIRI Chemotherapy in Patients with Metastatic Colorectal Cancer
Se Hyun Kim, Kyu Hyun Park, Sang Joon Shin, Kang Young Lee, Tae Il Kim, Nam Kyu Kim, Sun Young Rha, Jae Kyung Roh, Joong Bae Ahn
Cancer Res Treat. 2016;48(1):208-215.   Published online April 24, 2015
DOI: https://doi.org/10.4143/crt.2014.314
AbstractAbstract PDFPubReaderePub
Purpose
Hypermethylation of the CpG island of p16INK4a occurs in a significant proportion of colorectal cancer (CRC). We aimed to investigate its predictive role in CRC patients treated with 5-fluorouracil, leucovorin, irinotecan (FOLFIRI), and cetuximab.
Materials and Methods
Pyrosequencing was used to identify KRASmutation and hypermethylation of 6 CpG island loci (p16, p14, MINT1, MINT2, MINT31, and hMLH1) in DNA extracted from formalin-fixed paraffin-embedded specimens. Logistic regression and Cox regression were performed for analysis of the relation between methylation status of CpG island methylator phenotype (CIMP) markers including p16 and clinical outcome.
Results
Hypermethylation of the p16 gene was detected in 14 of 49 patients (28.6%) and showed significant association with KRASmutation (Fisher exact, p=0.01) and CIMP positivity (Fisher exact, p=0.002). Patients with p16-unmethylated tumors had significantly longer time to progression (TTP; median, 9.0 months vs. 3.5 months; log-rank, p=0.001) and overall survival (median, 44.9 months vs. 16.4 months; log-rank, p=0.008) than those with p16-methylated tumors. Patients with both KRAS and p16 aberrancy (n=6) had markedly shortened TTP (median, 2.8 months) compared to those with either KRAS or p16 aberrancy (n=11; median, 8.6 months; p=0.021) or those with neither (n=32; median, 9.0 months; p < 0.0001). In multivariate analysis, KRAS mutation and p16 methylation showed independent association with shorter TTP (KRAS mutation: hazard ratio [HR], 3.21; p=0.017; p16 methylation: HR, 2.97; p=0.027).
Conclusion
Hypermethylation of p16 was predictive of clinical outcome in metastatic CRC patients treated with cetuximab and FOLFIRI, irrespective of KRAS mutation.

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Novel Methods for Clinical Risk Stratification in Patients with Colorectal Liver Metastases
Ki-Yeol Kim, Nam Kyu Kim, In-Ho Cha, Joong Bae Ahn, Jin Sub Choi, Gi-Hong Choi, Joon Suk Lim, Kang Young Lee, Seung Hyuk Baik, Byung Soh Min, Hyuk Hur, Jae Kyung Roh, Sang Joon Shin
Cancer Res Treat. 2015;47(2):242-250.   Published online September 11, 2014
DOI: https://doi.org/10.4143/crt.2014.066
AbstractAbstract PDFPubReaderePub
Purpose
Colorectal cancer patients with liver-confined metastases are classified as stage IV, but their prognoses can differ from metastases at other sites. In this study, we suggest a novel method for risk stratification using clinically effective factors. Materials and Methods Data on 566 consecutive patients with colorectal liver metastasis (CLM) between 1989 and 2010 were analyzed. This analysis was based on principal component analysis (PCA). Results The survival rate was affected by carcinoembryonic antigen (CEA) level (p < 0.001; risk ratio, 1.90), distribution of liver metastasis (p=0.014; risk ratio, 1.46), and disease-free interval (DFI; p < 0.001; risk ratio, 1.98). When patients were divided into three groups according to PCA score using significantly affected factors, they showed significantly different survival patterns (p < 0.001). Conclusion The PCA scoring system based on CEA level, distribution of liver metastasis, and DFI may be useful for preoperatively determining prognoses in order to assist in clinical decisionmaking and designing future clinical trials for CLM treatment.

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Prognosis and Quality of Life of Non - resectable Gastric Cancer
Kang Young Lee, Yong Il Kim, Sung Hoon Noh, Jin Sik Min
J Korean Cancer Assoc. 1996;28(1):35-43.
AbstractAbstract PDF
The records of 217 patients with proven non-resectable gastric cancer were studied at Yonsei University Hospital over the 4 years period from January 1990, to December 1993 to clarify Quality of life of gastric cancer patients who could not be resected. The mean survival time of total patients was 10.5 months.(Male: 10.6, Female; 10.4) The survival time was affected by gross type and histologic type. Survivals according to the Borrmann type were as follows; Borrmann type I: 11.5 months, II: 11.3 months, III: 10.2 months, IV; 8.2 months. Survivals according to the histological type were as follows; well differentiated: 20.3 months, moderately differentiated: ll.5 months, poorly differentiated: 9.2 months, signet ring cell carcinoma: 7.9 months. The age, sex and cause of non-resectability did not affect the survival. The mean score of QOL(quality of life) according to Spitzer index was 4.8. The QOL was affected by histological type and type of operation. QOL index scores according to histo logic type were as follows; well differentiated: 6.4, moderately differentiated: 5.5, poorly differentiated: 4.7 and signet ring cell type: 3.5. QOL index scores according to type of operation were as follows; by pass procedure: 5.6, Explo-lapa & closure: 4.0. In conclusion, we could confirm the bad limited survival and quality of life of non-resectable gastric cancer patients. We suggest a new therapeutic approach to improve the survival and QOL of non-resectable gastric cancer patients.
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