Albumin-Bilirubin Grade as Predictor of Postoperative Outcomes and Survival in Hepatocellular Carcinoma: An Experience From a High-Volume Tertiary Cancer Center in India.
In a retrospective cohort of 333 patients undergoing curative-intent hepatectomy for hepatocellular carcinoma, higher preoperative ALBI grade was associated with more postoperative liver-related complications and independently predicted 6-month mortality and poorer overall survival.
Open original publication →What the AI sees
In a retrospective cohort of 333 patients undergoing curative-intent hepatectomy for hepatocellular carcinoma, higher preoperative ALBI grade was associated with more postoperative liver-related complications and independently predicted 6-month mortality and poorer overall survival.
Research significance
The evidence supports ALBI as an accessible prognostic and perioperative risk-stratification marker in this surgical cohort; it is reasonable but unproven to infer that incorporating ALBI into resection planning could improve patient selection or reduce postoperative harm, and no pediatric-specific benefit is established.
Source abstract
BACKGROUND: Outcomes in hepatocellular carcinoma (HCC) depend on tumor biology and hepatic functional reserve. The albumin-bilirubin (ALBI) grade, developed by Johnson et al. in a Japanese cohort undergoing resection or sorafenib, quantifies hepatic reserve. We aimed to validate ALBI in a large, predominantly noncirrhotic Indian surgical cohort selected by conventional preoperative work-up (Child-Turcotte-Pugh score, Barcelona Clinic Liver Cancer (BCLC) and Hong Kong Liver Cancer (HKLC) staging, future liver remnant), to assess its incremental value for patient selection. AIMS: The aim of the study is to evaluate preoperative ALBI grade as a predictor of survival and postoperative complications after curative hepatectomy for HCC. METHODS: This retrospective study included 333 patients undergoing curative-intent hepatectomy for HCC at a tertiary cancer center in India (2010-2023). ALBI grade was calculated from preoperative ALBI. Primary endpoint: overall survival (OS). Secondary endpoints: posthepatectomy liver failure (PHLF), bile leak (PHBL), major complications (Clavien-Dindo ≥ IIIa), 6-month mortality, and recurrence-free survival (RFS). Multivariable logistic and Cox regression assessed ALBI as an independent predictor, with sensitivity analysis excluding the small, unstable ALBI grade 3 subgroup. RESULTS: ALBI grade distribution: grade 1 (54.4%), grade 2 (44.1%), grade 3 (1.5%). PHLF rose from 3.3% to 4.1% and 40% across grades (P = 0.019); bile leak, 2.2%, 7.5%, and 40% (P = 0.002); 6-month mortality, 9.9%, 12.9%, and 60% (P = 0.013). Median OS declined from 96.5 to 59.4 to 4.0 months across grades (log-rank P = 0.013). ALBI independently predicted 6-month mortality (adjusted odds ratio [OR]: 8.94, P = 0.020) and OS (grade 2: adjusted hazard ratio [HR]: 1.64, P = 0.005). RFS showed a borderline association in the primary analysis (grade 2: adjusted HR: 1.39, P = 0.024), reaching significance on grades 1-2 sensitivity analysis (log-rank P = 0.049). ALBI retained prognostic significance despite surgeons tailoring resection extent to hepatic reserve. CONCLUSION: Preoperative ALBI grade independently predicts survival, liver-specific complications, and early mortality after HCC hepatectomy, offering clinically accessible risk stratification complementary to tumor staging and supporting its integration into preoperative assessment and surgical decision-making.