Work

Complementary Prognostic Value of ALBI Grade and Child–Pugh Classification in HCC Treated With SBRT

Year: 2026

Type: article

Abstract: Background/Aim: Accurate assessment of liver function is essential for selecting patients with hepatocellular carcinoma (HCC) undergoing stereotactic body radiotherapy (SBRT). In this study, we examined whether the albumin–bilirubin (ALBI) grade and the Child–Pugh classification provide independent prognostic information when modeled concurrently. Patients and Methods: A retrospective analysis was conducted on 102 patients with HCC who received initial SBRT (2013-2020) and were classified as ALBI grades 1-2 and Child–Pugh classes A-B. Both classifications were entered simultaneously into a multivariable Cox proportional hazards model adjusted for age, sex, viral hepatitis status, time since HCC diagnosis, and prior local treatments. Model discrimination was evaluated using the concordance index (C-index) and the Akaike information criterion (AIC). Results: The median follow-up was 52 months, and the median overall survival (OS) was 71 months. In the multivariable analysis, both ALBI grade 2 [hazard ratio (HR)=2.20; 95%confidence interval (CI)=1.07-4.51; p=0.032] and Child–Pugh class B (HR=3.70; 95%CI=1.77-7.72; p<0.001) were independently associated with poorer OS. The combined model incorporating both classifications showed improved discrimination compared with either classification alone (C-index, 0.7283 vs. 0.6976 and 0.7104; ΔAIC ≥2.85), indicating a complementary prognostic value. ALBI grade worsening at six months identified nonclassic radiation-induced liver disease in 21.5% of patients versus 7.5% identified by a ≥2-point increase in the Child–Pugh score, with 90% nonoverlap between criteria. Conclusion: ALBI grade 2 and Child–Pugh class B were independently associated with OS, with neither exhibiting clear superiority. Their combined use – ALBI grade for objective biochemical stratification and Child–Pugh for clinical assessment incorporating ascites and encephalopathy – may provide a more comprehensive evaluation than either system alone.

Source: Anticancer Research

DOI: 10.21873/anticanres.18256

Authors: DAISUKE NAKAMURA, YASUHIDE MOTOYOSHI, SHINYA NAGAOKA, ATSUMASA KOMORI, RYO TOYA

Institutions: Nagasaki Medical Center, Nagasaki University

Language: English

Topic: Hepatocellular Carcinoma Treatment and Prognosis

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

OpenAlex ID: W7166525350

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