A New Tumor Burden Score and Albumin–Bilirubin Grade-Based Prognostic Model for Hepatocellular Carcinoma

SIMPLE SUMMARY: The survival of patients with hepatocellular carcinoma (HCC) is highly variables, due to heterogeneous tumor burden and liver dysfunction. Tumor burden score (TBS) is a continuous variable to measure the extent of tumor involvement, and the albumin–bilirubin (ALBI) grade is an objective model to estimate hepatic functional reserve. Six prognostic predictors—including TBS, ALBI grade, ascites, serum α-fetoprotein level, vascular invasion or distant metastasis, and performance status—were linked with survival in a multivariate Cox model. We used these predictors to establish a new prognostic model—the TBS–ALBI system—to predict patient outcomes. Significant survival differences were found in different TBS–ALBI scores in the derivation and validation cohorts. This new system can also discriminate survival differences in patients with different viral etiologies, cancer stages, and treatment modalities. This study shows that the TBS–ALBI system is a feasible and user-friendly prognostic model for HCC. ABSTRACT: The prognosis of hepatocellular carcinoma (HCC) varies widely due to variable tumor extent and liver reserve. We aimed to develop and validate a new prognostic model based on tumor burden score (TBS) and albumin–bilirubin (ALBI) grade for HCC. We prospectively identified 3794 HCC patients who were randomized into derivation and validation groups. Survival predictors were evaluated by a multivariate Cox model. The TBS–ALBI system allocated two points for high TBS and ALBI grade 3, and one point each for the presence of ascites, serum α-fetoprotein ≥ 400 ng/mL, vascular invasion or distant metastasis, performance status 2–4, medium TBS, and ALBI grade 2, with a maximal score of 8 points. Significant survival differences were found across different TBS–ALBI score groups in the validation cohort (all p < 0.001). The TBS–ALBI system had the lowest corrected Akaike information criterion (AICc) and the highest homogeneity compared with other proposed staging models. The discriminative ability of the TBS–ALBI system was consistently stable across different viral etiologies, cancer stages, and treatment strategies. Conclusions: This new TBS–ALBI system is a feasible and robust prognostic system in comparison with other systems; it is a user-friendly tool for long-term outcome assessment independent of treatment modality and cancer stage in HCC.