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Complementary Prognostic Value of ALBI Grade and Child-Pugh Classification in HCC Treated With SBRT
Daisuke Nakamura1,2, Yasuhide Motoyoshi3,4, Shinya Nagaoka3,4
1Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; dai-naka@nagasaki-u.ac.jp.
Anticancer Research
|June 29, 2026
Summary
The albumin-bilirubin (ALBI) grade and Child-Pugh classification independently predict survival in hepatocellular carcinoma (HCC) patients undergoing stereotactic body radiotherapy (SBRT). Combining ALBI and Child-Pugh offers a more comprehensive prognostic assessment for HCC treatment.
Area of Science:
- Hepatocellular Carcinoma (HCC) Research
- Radiation Oncology
- Liver Function Assessment
Background:
- Accurate liver function assessment is crucial for hepatocellular carcinoma (HCC) patients undergoing stereotactic body radiotherapy (SBRT).
- The albumin-bilirubin (ALBI) grade and Child-Pugh classification are common tools for assessing liver function.
- Their independent prognostic value in the context of SBRT for HCC requires clarification.
Purpose of the Study:
- To evaluate if the ALBI grade and Child-Pugh classification provide independent prognostic information when used concurrently in HCC patients treated with SBRT.
- To compare the prognostic discrimination of each classification alone versus their combined use.
- To assess the utility of these classifications in identifying radiation-induced liver disease.
Main Methods:
- Retrospective analysis of 102 HCC patients treated with SBRT (2013-2020).
- Patients were classified using ALBI grades 1-2 and Child-Pugh classes A-B.
- Multivariable Cox proportional hazards model used to assess independent prognostic value, adjusted for clinical factors. Model discrimination evaluated using C-index and AIC.
Main Results:
- Both ALBI grade 2 (HR=2.20) and Child-Pugh class B (HR=3.70) were independently associated with poorer overall survival (OS).
- The combined model demonstrated improved discrimination (C-index 0.7283) compared to either classification alone.
- ALBI grade worsening identified nonclassic radiation-induced liver disease in 21.5% of patients, with significant nonoverlap with Child-Pugh score changes.
Conclusions:
- ALBI grade 2 and Child-Pugh class B are independent predictors of OS in HCC patients undergoing SBRT.
- Neither classification alone is superior; their combined use offers a more comprehensive prognostic evaluation.
- Integrating ALBI for biochemical stratification and Child-Pugh for clinical assessment (ascites, encephalopathy) enhances patient evaluation.