Comparative Analysis of Albumin-Bilirubin (ALBI) Score and Child-Pugh Score for Prognostic Stratification in Hepatocellular Carcinoma Patients: A Single-Center Experience From North India.
In a retrospective single-center cohort of 210 patients with hepatocellular carcinoma, ALBI and especially modified ALBI provided better overall-survival prognostic discrimination than Child-Pugh classification, including additional stratification within Child-Pugh class A.
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In a retrospective single-center cohort of 210 patients with hepatocellular carcinoma, ALBI and especially modified ALBI provided better overall-survival prognostic discrimination than Child-Pugh classification, including additional stratification within Child-Pugh class A.
Research significance
The reported evidence supports ALBI as an objective prognostic stratification tool; it may, by inference, improve treatment selection or trial stratification, but the record does not show that ALBI-guided care changes therapy, toxicity, or survival, and pediatric applicability is unestablished.
Source abstract
Background Accurate assessment of hepatic reserve is essential in hepatocellular carcinoma (HCC). While the Child-Pugh (CP) score remains widely used, subjectivity in its parameters limits reproducibility. The Albumin-Bilirubin (ALBI) score offers an objective alternative, but contemporary Indian data comparing the two remain limited. Aim To compare the prognostic performance of the Child-Pugh (CP) score, the ALBI score, and the modified ALBI (mALBI) grade in predicting survival outcomes among patients with hepatocellular carcinoma treated at a North Indian tertiary cancer center using an extended follow-up dataset. Methods This retrospective cohort included consecutive patients diagnosed with HCC between January 2020 and December 2024. Eligibility required radiologic or histologic HCC and baseline CP class A or B. ALBI and CP scores were calculated at diagnosis. Survival analysis was censored on June 30, 2025, providing mature overall survival (OS) and progression-free survival (PFS) data (median follow-up 24.0 months). Kaplan-Meier methods, Cox regression, Harrell's C-index, and time-dependent receiver operating characteristic (ROC) analyses were performed. Results A total of 210 patients were included. ALBI grade distribution was ALBI-1 in 67 patients (31.9%), ALBI-2 in 125 patients (59.5%), and ALBI-3 in 18 patients (8.6%). Child-Pugh classification showed CP-A in 155 patients (74.0%) and CP-B in 55 patients (26.0%). Median OS for the cohort was 14.2 months (95% CI: 11.8-16.9), and median PFS was 9.5 months (95% CI: 7.8-11.4). ALBI demonstrated superior prognostic discrimination compared with Child-Pugh classification (C-index 0.68 vs. 0.61, p=0.024), while modified ALBI showed the highest discriminatory performance (C-index 0.71). ALBI also identified significant prognostic heterogeneity within CP-A patients that was not captured by Child-Pugh classification. Conclusion In this retrospective single-center cohort, the ALBI score demonstrated better prognostic discrimination than the Child-Pugh score, particularly among patients with Child-Pugh class A liver function. These findings support consideration of ALBI as an objective tool for risk stratification in HCC; however, prospective multicenter studies are needed to validate its broader clinical application.