Predictive Power of the Albumin–Bilirubin Score for Hepatotoxicity in Stereotactic Ablative Radiation Therapy for Hepatocellular Carcinoma

SIMPLE SUMMARY: The albumin–bilirubin (ALBI) score has been proposed as an alternative to the Child-Turcotte-Pugh (CTP) classification for assessing liver function. We evaluated the prognostic performance of the ALBI score and determined the optimal cutoff point as a potential predictor of hepatotoxicity after stereotactic body radiation therapy. To compare ALBI and CTP scores, receiver operating characteristic (ROC) curves were calculated, and DeLong’s test was used for statistical analysis. The optimal ALBI score cutoff was calculated. The baseline ALBI score was an independent prognostic factor for hepatotoxicity. The optimal ALBI cutoff value to predict CTP increase was −2.47, which is higher than the widely accepted reference point for ALBI grades 1 and 2. The ALBI score had greater predictive power compared to the CTP score. ABSTRACT: Assessment of liver function is crucial in predicting treatment outcomes for hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic performance of the albumin–bilirubin (ALBI) score for predicting hepatotoxicity following stereotactic body radiation therapy (SBRT) in HCC patients. A retrospective analysis was conducted on 123 HCC cases treated between 2018 and 2020. ALBI and Child-Turcotte-Pugh (CTP) scores were calculated, and hepatotoxicity was defined as a post-SBRT CTP score increase ≥2. Receiver operating characteristic (ROC) curves were used for comparison. The optimal cutoff value of the ALBI score was determined. Among the 121 patients analyzed, hepatotoxicity occurred in 5%. The ALBI score showed better predictive accuracy (area under the ROC curve: 0.77) than the CTP score. The optimal cutoff value of the ALBI score was −2.47, with a sensitivity of 85.7% and a specificity of 71.1%. Multivariable analysis revealed that ALBI score and PTV were significant factors for hepatotoxicity. In conclusion, the ALBI score demonstrated prognostic value for hepatotoxicity prediction after SBRT in HCC patients. Considering the ALBI score and PTV provides valuable insights for assessing hepatotoxicity risk during SBRT treatment for HCC.