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

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.

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).

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.

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.