{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T04:23:01Z","timestamp":1783052581975,"version":"3.54.6"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Numerous studies have reported the association between preoperative albumin-bilirubin (ALBI) grade and survival outcomes in patients with cholangiocarcinoma (CCA). However, the results are inconsistent. Therefore, we conducted a meta-analysis to comprehensively evaluate the relationship between ALBI grade and prognosis of CCA patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We retrieved the databases (Pubmed,Embase and Web of science) to search articles about the association of ALBI grade with prognostic value in CCA patients. Hazard ratios (HR) and 95% confidence intervals (CI) were used to summarize survival outcomes. STATA 12.0 was used to implement the data analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>11 studies from 10 articles comprising 2841 patients were included in the meta-analysis. The pooled results showed that high ALBI grade was significantly associated with poor overall survival (OS) (HR: 1.75, 95% CI: 1.32\u20132.31) and relapse-free survival(RFS)(HR:1.95;95%CI:1.37\u20132.13). Subgroup analysis further showed that high ALBI grade had better predictive value for Asian population(HR:1.92;95%CI:1.46\u20132.51). Sensitivity analysis indicated that the results of the meta-analysis were stable.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>High ALBI grade predicted adverse survival outcomes in CCA patients. ALBI grade may be an efficient and convenient prognostic indicator in CCA patients for Asian population.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0321758","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T20:03:51Z","timestamp":1746648231000},"page":"e0321758","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of albumin-bilirubin grade with survival outcomes in patients with cholangiocarcinoma"],"prefix":"10.1371","volume":"20","author":[{"given":"Jing","family":"Ye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7993-8891","authenticated-orcid":true,"given":"Rongqiang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianguo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wangbin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weixing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"issue":"6","key":"pone.0321758.ref001","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/S0168-8278(02)00297-0","article-title":"Changing international trends in mortality rates for liver, biliary and pancreatic tumours","volume":"37","author":"SA Khan","year":"2002","journal-title":"J Hepatol"},{"issue":"5","key":"pone.0321758.ref002","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrgastro.2016.51","article-title":"Expert consensus document: Cholangiocarcinoma: current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA)","volume":"13","author":"JM Banales","year":"2016","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"22","key":"pone.0321758.ref003","doi-asserted-by":"crossref","first-page":"3929","DOI":"10.1002\/cncr.28312","article-title":"Multidisciplinary approaches to intrahepatic cholangiocarcinoma","volume":"119","author":"SK Maithel","year":"2013","journal-title":"Cancer"},{"issue":"5","key":"pone.0321758.ref004","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1001\/jamasurg.2013.5168","article-title":"A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience","volume":"149","author":"O Hyder","year":"2014","journal-title":"JAMA Surg"},{"key":"pone.0321758.ref005","doi-asserted-by":"crossref","first-page":"829407","DOI":"10.3389\/fonc.2022.829407","article-title":"Tumor Burden Score Stratifies Prognosis of Patients With Intrahepatic Cholangiocarcinoma After Hepatic Resection: A Retrospective, Multi-Institutional Study","volume":"12","author":"H Li","year":"2022","journal-title":"Front Oncol"},{"issue":"1","key":"pone.0321758.ref006","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1186\/s12885-021-09035-5","article-title":"Prognostic value and predication model of microvascular invasion in patients with intrahepatic cholangiocarcinoma: a multicenter study from China","volume":"21","author":"Y Chen","year":"2021","journal-title":"BMC Cancer"},{"issue":"4","key":"pone.0321758.ref007","doi-asserted-by":"crossref","first-page":"566","DOI":"10.3892\/mco.2017.1166","article-title":"Glasgow Prognostic Score predicts prognosis of intrahepatic cholangiocarcinoma","volume":"6","author":"Q-X Pan","year":"2017","journal-title":"Mol Clin Oncol"},{"issue":"1","key":"pone.0321758.ref008","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1186\/s12885-017-3464-5","article-title":"Risk stratification system to predict recurrence of intrahepatic cholangiocarcinoma after hepatic resection","volume":"17","author":"S Jeong","year":"2017","journal-title":"BMC Cancer"},{"issue":"6","key":"pone.0321758.ref009","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1200\/JCO.2014.57.9151","article-title":"Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade","volume":"33","author":"PJ Johnson","year":"2015","journal-title":"J Clin Oncol"},{"issue":"8","key":"pone.0321758.ref010","doi-asserted-by":"crossref","first-page":"553","DOI":"10.21037\/atm.2020.02.116","article-title":"Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma and other liver diseases","volume":"8","author":"D Feng","year":"2020","journal-title":"Ann Transl Med"},{"issue":"2","key":"pone.0321758.ref011","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/s00270-020-02637-9","article-title":"Assessment of the Outcomes of Intrahepatic Cholangiocarcinoma After Ultrasound-Guided Percutaneous Microwave Ablation Based on Albumin-Bilirubin Grade","volume":"44","author":"H Yang","year":"2021","journal-title":"Cardiovasc Intervent Radiol"},{"key":"pone.0321758.ref012","doi-asserted-by":"crossref","first-page":"769696","DOI":"10.3389\/fonc.2021.769696","article-title":"Prediction Efficacy of Prognostic Nutritional Index and Albumin-Bilirubin Grade in Patients With Intrahepatic Cholangiocarcinoma After Radical Resection: A Multi-Institutional Analysis of 535 Patients","volume":"11","author":"Q Li","year":"2021","journal-title":"Front Oncol"},{"issue":"8","key":"pone.0321758.ref013","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1111\/hepr.13673","article-title":"Prognosis of intrahepatic cholangiocarcinoma stratified by albumin-bilirubin grade","volume":"51","author":"S Kaneko","year":"2021","journal-title":"Hepatol Res"},{"issue":"1","key":"pone.0321758.ref014","first-page":"328","article-title":"Predictive value of the albumin-bilirubin grade on long-term outcomes of CT-guided percutaneous microwave ablation in intrahepatic cholangiocarcinoma","volume":"36","author":"J-Y Ni","year":"2019","journal-title":"Int J Hyperthermia"},{"key":"pone.0321758.ref015","doi-asserted-by":"crossref","first-page":"824541","DOI":"10.3389\/fonc.2022.824541","article-title":"Predicting Disease-Specific Survival for Patients With Primary Cholangiocarcinoma Undergoing Curative Resection by Using a Decision Tree Model","volume":"12","author":"B Quan","year":"2022","journal-title":"Front Oncol"},{"issue":"4","key":"pone.0321758.ref016","doi-asserted-by":"crossref","first-page":"715","DOI":"10.21037\/jgo.2020.04.01","article-title":"Albumin-bilirubin grade as a prognostic indicator for patients with non-hepatocellular primary and metastatic liver malignancy undergoing Yttrium-90 radioembolization using resin microspheres","volume":"11","author":"A Azar","year":"2020","journal-title":"J Gastrointest Oncol"},{"issue":"2","key":"pone.0321758.ref017","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s12029-022-00832-0","article-title":"Clinical Utility of Albumin Bilirubin Grade as a Prognostic Marker in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: a Systematic Review and Meta-analysis","volume":"54","author":"G Mishra","year":"2023","journal-title":"J Gastrointest Cancer"},{"issue":"11","key":"pone.0321758.ref018","first-page":"2575","article-title":"Value of albumin-bilirubin grade in predicting liver function changes and prognosis of hepatocellular carcinoma patients undergoing transarterial chemoembolization: A Meta-analysis","volume":"37","author":"WM Yu","year":"2021","journal-title":"J Clinical Hepatobiliary Disease"},{"issue":"9","key":"pone.0321758.ref019","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"A Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"pone.0321758.ref020","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1745-6215-8-16","article-title":"Practical methods for incorporating summary time-to-event data into meta-analysis","volume":"8","author":"JF Tierney","year":"2007","journal-title":"Trials"},{"issue":"2","key":"pone.0321758.ref021","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1037\/1082-989X.11.2.193","article-title":"Assessing heterogeneity in meta-analysis: Q statistic or I2 index?","volume":"11","author":"TB Huedo-Medina","year":"2006","journal-title":"Psychol Methods"},{"key":"pone.0321758.ref022","doi-asserted-by":"crossref","first-page":"819998","DOI":"10.3389\/fped.2022.819998","article-title":"The Global Prevalence of Amblyopia in Children: A Systematic Review and Meta-Analysis","volume":"10","author":"B Hu","year":"2022","journal-title":"Front Pediatr"},{"key":"pone.0321758.ref023","doi-asserted-by":"crossref","first-page":"525","DOI":"10.3389\/fonc.2020.00525","article-title":"Assessment of Liver Function for Evaluation of Long-Term Outcomes of Intrahepatic Cholangiocarcinoma: A Multi-Institutional Analysis of 620 Patients","volume":"10","author":"H Li","year":"2020","journal-title":"Front Oncol"},{"issue":"4","key":"pone.0321758.ref024","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1245\/s10434-019-08067-3","article-title":"A Machine-Based Approach to Preoperatively Identify Patients with the Most and Least Benefit Associated with Resection for Intrahepatic Cholangiocarcinoma: An International Multi-institutional Analysis of 1146 Patients","volume":"27","author":"DI Tsilimigras","year":"2020","journal-title":"Ann Surg Oncol"},{"key":"pone.0321758.ref025","first-page":"8902146","article-title":"Albumin-Bilirubin Grade as a Novel Predictor of Survival in Advanced Extrahepatic Cholangiocarcinoma","author":"Y Wang","year":"2018","journal-title":"Gastroenterol Res Pract"},{"key":"pone.0321758.ref026","doi-asserted-by":"crossref","first-page":"434","DOI":"10.3389\/fonc.2020.00434","article-title":"A Novel Prognostic Nomogram for Patients With Recurrence of Intrahepatic Cholangiocarcinoma After Initial Surgery","volume":"10","author":"K-L Xing","year":"2020","journal-title":"Front Oncol"},{"issue":"5","key":"pone.0321758.ref027","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.amjsurg.2004.07.034","article-title":"Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients","volume":"188","author":"N Farnsworth","year":"2004","journal-title":"Am J Surg"},{"key":"pone.0321758.ref028","doi-asserted-by":"crossref","first-page":"914997","DOI":"10.3389\/fonc.2022.914997","article-title":"Prognostic Value of Platelet-Albumin-Bilirubin Grade in Child-Pugh A and B Patients With Hepatocellular Carcinoma: A Meta-Analysis","volume":"12","author":"R Liu","year":"2022","journal-title":"Front Oncol"},{"issue":"11","key":"pone.0321758.ref029","doi-asserted-by":"crossref","first-page":"6223","DOI":"10.1245\/s10434-021-09593-9","article-title":"Clinical Significance of Preoperative Albumin-Bilirubin Grade in Pancreatic Cancer","volume":"28","author":"T Imamura","year":"2021","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"pone.0321758.ref030","doi-asserted-by":"crossref","first-page":"3868","DOI":"10.1245\/s10434-022-11445-z","article-title":"Association of Albumin-Bilirubin Grade and Myosteatosis with its Prognostic Significance for Patients with Colorectal Cancer","volume":"29","author":"H-H Koh","year":"2022","journal-title":"Ann Surg Oncol"},{"issue":"5","key":"pone.0321758.ref031","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.21037\/jgo-23-599","article-title":"High albumin-bilirubin grade predicts worse short-term complications in gastric cancer patients with metabolic syndrome: a retrospective study","volume":"14","author":"X Luo","year":"2023","journal-title":"J Gastrointest Oncol"},{"issue":"1","key":"pone.0321758.ref032","doi-asserted-by":"crossref","first-page":"100348","DOI":"10.1016\/j.esmoop.2021.100348","article-title":"Assessment of the albumin-bilirubin grade as a prognostic factor in patients with non-small-cell lung cancer receiving anti-PD-1-based therapy","volume":"7","author":"K Takada","year":"2022","journal-title":"ESMO Open"},{"issue":"9","key":"pone.0321758.ref033","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1093\/jjco\/hyad069","article-title":"Prognostic significance of pre-treatment albumin-bilirubin grade in metastatic urothelial carcinoma receiving pembrolizumab","volume":"53","author":"S Yamashita","year":"2023","journal-title":"Jpn J Clin Oncol"},{"key":"pone.0321758.ref034","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.jss.2023.08.056","article-title":"Clinical Significance of Albumin-Bilirubin Grade in Thoracic Esophageal Squamous Cell Carcinoma","volume":"295","author":"T Kitahama","year":"2024","journal-title":"J Surg Res"},{"issue":"9","key":"pone.0321758.ref035","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.3390\/jcm10092011","article-title":"Prognostic Value of the Albumin-Bilirubin Grade for the Prediction of Post-Hepatectomy Liver Failure: A Systematic Review and Meta-Analysis","volume":"10","author":"G Marasco","year":"2021","journal-title":"J Clin Med"},{"issue":"7","key":"pone.0321758.ref036","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1097\/MEG.0000000000001618","article-title":"Prognostic role of preoperative albumin-bilirubin grade on patients with hepatocellular carcinoma after surgical resection: a systematic review and meta-analysis","volume":"32","author":"L Geng","year":"2020","journal-title":"Eur J Gastroenterol Hepatol"},{"issue":"10","key":"pone.0321758.ref037","doi-asserted-by":"crossref","first-page":"3338","DOI":"10.1016\/j.transproceed.2019.08.027","article-title":"Application of the Albumin-Bilirubin Grade in Predicting the Prognosis of Patients With Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis","volume":"51","author":"L Xu","year":"2019","journal-title":"Transplant Proc"},{"issue":"16","key":"pone.0321758.ref038","doi-asserted-by":"crossref","first-page":"4250","DOI":"10.3748\/wjg.v22.i16.4250","article-title":"Predictive effects of bilirubin on response of colorectal cancer to irinotecan-based chemotherapy","volume":"22","author":"Q-Q Yu","year":"2016","journal-title":"World J Gastroenterol"},{"issue":"2","key":"pone.0321758.ref039","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1053\/j.seminoncol.2014.03.006","article-title":"Association of abnormal plasma bilirubin with aggressive hepatocellular carcinoma phenotype","volume":"41","author":"BI Carr","year":"2014","journal-title":"Semin Oncol"},{"issue":"2","key":"pone.0321758.ref040","first-page":"474","article-title":"Malignant ascites: demographics, therapeutic efficacy and predictors of survival","volume":"6","author":"JR Mackey","year":"1996","journal-title":"Can J Oncol"},{"issue":"4","key":"pone.0321758.ref041","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.suc.2011.04.004","article-title":"The relationships of nutrients, routes of delivery, and immunocompetence","volume":"91","author":"S Jayarajan","year":"2011","journal-title":"Surg Clin North Am"},{"issue":"2","key":"pone.0321758.ref042","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/eji.201646423","article-title":"Nutritional effects on T-cell immunometabolism","volume":"47","author":"S Cohen","year":"2017","journal-title":"Eur J Immunol"},{"issue":"2","key":"pone.0321758.ref043","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1159\/000471807","article-title":"Role of Albumin in Growth Inhibition in Hepatocellular Carcinoma","volume":"93","author":"E Ba\u011f\u0131rsak\u00e7\u0131","year":"2017","journal-title":"Oncology"},{"issue":"2","key":"pone.0321758.ref044","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1207\/S15327914nc392_8","article-title":"Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss","volume":"39","author":"DC McMillan","year":"2001","journal-title":"Nutr Cancer"},{"issue":"2","key":"pone.0321758.ref045","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/coa.13454","article-title":"Prognostic role of pre-treatment serum albumin in patients with nasopharyngeal carcinoma: A meta-analysis and systematic review","volume":"45","author":"H Yang","year":"2020","journal-title":"Clin Otolaryngol"},{"key":"pone.0321758.ref046","doi-asserted-by":"crossref","first-page":"1039121","DOI":"10.3389\/fmolb.2022.1039121","article-title":"The association between albumin levels and survival in patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis","volume":"9","author":"DC Guven","year":"2022","journal-title":"Front Mol Biosci"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321758","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T20:04:00Z","timestamp":1746648240000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321758"}},"subtitle":[],"editor":[{"given":"Xiaosheng","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":46,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0321758","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,7]]}}}