Modified Child-Pugh grade vs albumin-bilirubin grade for predicting prognosis of hepatocellular carcinoma patients after hepatectomy

BACKGROUND: Hepatectomy is the main treatment for patients with hepatocellular carcinoma (HCC) and it has a high possibility for long-term cure potential. But the postoperative mortality and recurrence rates remain high. Since the long-term prognosis of HCC patients is strongly linked to liver function, preoperative assessment of liver function is very important for HCC patients. AIM: To compare the predictive power of the modified Child-Pugh (MCP) and albumin-bilirubin (ALBI) grades for the long-term outcome of HCC. METHODS: From January 2010 to June 2017, a total of 204 patients with HCC who underwent surgery at the Second Affiliated Hospital of Chongqing Medical University were enrolled in this retrospective study. Multivariate Cox regression analysis was used to determine the independent predictive factors of survival and relapse. The area under the curve (AUC) was used to evaluate the discriminative performance of the MCP grade and ALBI grade to predict the postoperative overall survival (OS) time and recurrence-free survival (RFS) time. RESULTS: The median OS and RFS times were 44.0 mo (range: 22.0-74.0 mo) and 22.0 mo (range: 5.0-45.0 mo), respectively. The median OS and RFS times of MCP grades 1, 2, and 3 patients were 60.0, 39.0, and 18.0 mo (P < 0.001) and 36.0, 15.0, and 7.0 mo (P < 0.001), respectively. The median OS and RFS times of ALBI grades 1, 2, and 3 patients were 56.0, 26.0, and 6.0 mo (P < 0.001) and 25.0, 10.0, and 3.0 mo (P = 0.003), respectively. Both the MCP and ALBI grades were more accurate than the Child-Pugh grade for predicting long-term prognosis. Further analysis demonstrated that for both predicting OS and RFS, the MCP grade performed better than the ALBI grade (AUC: 0.642 vs 0.605 for OS; 0.659 vs 0.594 for RFS). CONCLUSION: The MCP grade is more accurate than the ALBI grade for predicting long-term outcome of patients with HCC.