Prognostic Role of Albumin-Bilirubin Grade in Hepatocellular Carcinoma After Ultrasound-guided Percutaneous Radiofrequency Ablation: A Single-center Experience Over a Decade

Background: The albumin-bilirubin (ALBI) grade has been proposed to evaluate liver function and predict prognosis in patients with hepatocellular carcinoma (HCC). Data are scarce in terms of the clinical application of ALBI score in patients with HCC undergoing radiofrequency ablation (RFA). The current study sought to assess the prognostic efficacy of ALBI grade in early-stage HCC after RFA. Methods: We retrospectively reviewed 344 treatment-naive patients, whereby the overall survival (OS), recurrence-free survival (RFS), local tumor progression, and intrahepatic distant recurrence were assessed using Kaplan-Meier analysis. Predictors determining OS and RFS after RFA were analyzed using Cox proportional hazards analysis. Results: During a median follow-up time of 48.0 months (range: 2 to 158 mo), 48 patients had died because of tumor progression or liver failure. Patients with ALBI grade 2 had poorer OS (P=0.033) and RFS (P=0.002), and higher intrahepatic distant recurrence rate (P<0.001) than those with ALBI grade 1. Local tumor progression rates were comparable between the 2 groups (P=0.801). Multivariate analyses showed that ABLI grade 2 was the only independent risk factor for poor OS (hazard ratio=1.850, 95% confidence interval: 1.041-3.286, P=0.036) and poor RFS (hazard ratio=1.467, 95% confidence interval: 1.094-1.968, P=0.011) after RFA. For Child-Pugh grade A group, patients divided by ALBI grade 1 versus grade 2 showed significant differences in both OS and RFS (P=0.039 and 0.002). Conclusion: The ALBI grade can be used to discriminate long-term prognosis in patients with HCC following RFA and to further stratify prognosis in those with Child-Pugh grade A.