Prognostic role of the Child-Turcotte-Pugh classification and ALBI grade in patients without cirrhosis and hepatocellular carcinoma
Year: 2026
Type: article
Abstract: BACKGROUND & AIMS: While the Child-Turcotte-Pugh (CTP) classification and albumin-bilirubin (ALBI) grade are important clinical tools for risk stratification in patients with cirrhosis and hepatocellular carcinoma (HCC), there are no data on their prognostic ability in patients with HCC without cirrhosis. METHODS: Cohort 1 included patients with unresectable HCC and Barcelona Clinic Liver Cancer (BCLC) stage A-C from the Medical University of Vienna and Sorbonne University, Paris. Cohort 2 included patients with unresectable HCC treated with atezolizumab/bevacizumab or durvalumab/tremelimumab from two large international databases (AB-Real and DT-Real studies). We evaluated the prognostic value of the CTP classification and ALBI grade for overall survival (OS) using Cox regression analyses and time-dependent AUROCs. RESULTS: Cohort 1 included 184 patients without cirrhosis (CTP-B: n = 22/12.0%) and 1,173 patients with cirrhosis (CTP-B: n = 414/35.3%), and cohort 2 comprised 259 patients without cirrhosis (CTP B: n = 19/7.3%) and 841 patients with cirrhosis (CTP-B: n = 187/23.3%). CTP classification was independently associated with OS in cohorts 1 (adjusted hazard ratio 3.04, 95% CI 1.70-5.45, p <0.001) and 2 (adjusted hazard ratio 3.24, 95% CI 1.73-6.08, p <0.001), independent of BCLC stage and other relevant prognostic factors. Time-dependent AUROCs of CTP score were comparable at the analysed timepoints. Similar results were observed for ALBI grade. CONCLUSION: CTP classification and ALBI grade are associated with prognosis in patients with HCC without cirrhosis, and their prognostic performance is comparable to that in patients with cirrhosis and HCC. IMPACT AND IMPLICATIONS: Due to contemporary epidemiological changes, the prevalence of hepatocellular carcinoma without underlying cirrhosis is increasing. Liver function, alongside tumoral and clinical parameters, determines the management and treatment of patients with hepatocellular carcinoma. However, the role of liver function scores in patients with hepatocellular carcinoma without cirrhosis is less well known. In this retrospective study, we evaluated the role of the Child-Turcotte-Pugh classification and the albumin-bilirubin grade in multicentre cohorts of patients with different tumour stages. Both scores were associated with survival in patients with hepatocellular carcinoma without cirrhosis, with a prognostic power comparable to that in patients with cirrhosis and hepatocellular carcinoma.
Source: JHEP Reports
Authors: Lorenz Balcar, Leonardo Brunetti, Katharina Pomej, Abelina Kreuter, Claudia Angela Maria Fulgenzi, Ahmer Adnan, Tobias Meischl, Antonio D’Alessio, Giulia Manfredi, Hong Jae Chon, Naoshi Nishida, Pei-Chang Lee, Celina Ang, Anja Krall, Najib Ben Khaled, Bernardo Stefanini, Tiziana Pressiani, Joe Ramzi Eid, Anwar Saeed, Alessandro Parisi, Yi-Hsiang Huang, Ashwini Arvind, Caterina Vivaldi, Francesca Salani, Gianluca Masi, Natascha Röhlen, Arndt Vogel, Kornelius Schulze, Johann von Felden, Marianna Silletta, Michael Trauner, Ilario Giovanni Rapposelli, Henning Wege, Fabio Piscaglia, Peter R. Galle, Rudolf Stauber, Masatoshi Kudo, Amit G. Singal, Susanna V. Ulahannan, Haripriya Andanamala, Andrea Casadei-Gardini, Iakow Bolnykh, Sarah Mouri, Charles Roux, Ahmed Kaseb, Lorenza Rimassa, Beodeul Kang, Ciro Celsa, Michael Li, Mario Pirisi, Calogero Cammà, Giuseppe Cabibbo, Eleonora Alimenti, Massimo Iavarone, Pasquale Lombardi, Robin Kate Kelley, Marta Fortuny, Maria Reig, Andrea Dalbeni, Hidenori Toyoda, Wei-Fan Hsu, Chun-Yen Lin, Po Ting Lin, Bernhard Scheiner, Manon Allaire, David J. Pinato, Matthias Pinter
Institutions: Medical University of Vienna, Campus Bio Medico University Hospital, Imperial College London, Hanusch Hospital, Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, CHA University Bundang Medical Center, CHA University, Kindai University, Taipei Veterans General Hospital, Mount Sinai Hospital, Tisch Cancer Institute, Medical University of Graz, LMU Klinikum, Ludwig-Maximilians-Universität München, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, IRCCS Humanitas Research Hospital, The University of Texas MD Anderson Cancer Center, University of Kansas, The University of Kansas Cancer Center, Marche Polytechnic University, Azienda Ospedaliero-Universitaria delle Marche, National Yang Ming Chiao Tung University, The University of Texas Southwestern Medical Center, University of Pisa, Azienda Ospedaliera Universitaria Pisana, University Medical Center Freiburg, Medizinische Hochschule Hannover, Universität Hamburg, University Medical Center Hamburg-Eppendorf, Marienkrankenhaus Hamburg, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, University Medical Center of the Johannes Gutenberg University Mainz, OU Health Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Vita-Salute San Raffaele University, IRCCS Ospedale San Raffaele, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Humanitas University, University of Palermo, University of California, San Francisco, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Cattolica del Sacro Cuore, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, UCSF Helen Diller Family Comprehensive Cancer Center, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Centro de Investigación Biomédica en Red, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Ogaki Municipal Hospital, China Medical University Hospital, Chang Gung University, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,110
OpenAlex ID: W7215124282