Comparative Analysis of Albumin-Bilirubin (ALBI) Score and Child-Pugh Score for Prognostic Stratification in Hepatocellular Carcinoma Patients: A Single-Center Experience From North India.
In a retrospective single-center cohort of 210 patients with hepatocellular carcinoma, ALBI and modified ALBI grades showed better overall-survival prognostic discrimination than Child-Pugh classification, including additional stratification within Child-Pugh class A.
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In a retrospective single-center cohort of 210 patients with hepatocellular carcinoma, ALBI and modified ALBI grades showed better overall-survival prognostic discrimination than Child-Pugh classification, including additional stratification within Child-Pugh class A.
Research significance
The evidence supports ALBI as an objective prognostic stratification tool in this cohort; it may help inform treatment selection or risk-adapted monitoring, but that therapeutic utility is inferential, was not directly tested, and has no demonstrated pediatric applicability in the supplied record.
Source abstract
Background Accurate assessment of hepatic reserve is essential in hepatocellular carcinoma (HCC). While the Child-Pugh (CP) score remains widely used, subjectivity in its parameters limits reproducibility. The Albumin-Bilirubin (ALBI) score offers an objective alternative, but contemporary Indian data comparing the two remain limited. Aim To compare the prognostic performance of the Child-Pugh (CP) score, the ALBI score, and the modified ALBI (mALBI) grade in predicting survival outcomes among patients with hepatocellular carcinoma treated at a North Indian tertiary cancer center using an extended follow-up dataset. Methods This retrospective cohort included consecutive patients diagnosed with HCC between January 2020 and December 2024. Eligibility required radiologic or histologic HCC and baseline CP class A or B. ALBI and CP scores were calculated at diagnosis. Survival analysis was censored on June 30, 2025, providing mature overall survival (OS) and progression-free survival (PFS) data (median follow-up 24.0 months). Kaplan-Meier methods, Cox regression, Harrell's C-index, and time-dependent receiver operating characteristic (ROC) analyses were performed. Results A total of 210 patients were included. ALBI grade distribution was ALBI-1 in 67 patients (31.9%), ALBI-2 in 125 patients (59.5%), and ALBI-3 in 18 patients (8.6%). Child-Pugh classification showed CP-A in 155 patients (74.0%) and CP-B in 55 patients (26.0%). Median OS for the cohort was 14.2 months (95% CI: 11.8-16.9), and median PFS was 9.5 months (95% CI: 7.8-11.4). ALBI demonstrated superior prognostic discrimination compared with Child-Pugh classification (C-index 0.68 vs. 0.61, p=0.024), while modified ALBI showed the highest discriminatory performance (C-index 0.71). ALBI also identified significant prognostic heterogeneity within CP-A patients that was not captured by Child-Pugh classification. Conclusion In this retrospective single-center cohort, the ALBI score demonstrated better prognostic discrimination than the Child-Pugh score, particularly among patients with Child-Pugh class A liver function. These findings support consideration of ALBI as an objective tool for risk stratification in HCC; however, prospective multicenter studies are needed to validate its broader clinical application.