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