The comparison between albumin-bilirubin grade and Child-Pugh grade for assessing the prognosis of hepatocellular carcinoma after thermal ablation: a propensity score-matched analysis

BACKGROUND: Thermal ablation is one of the first-line treatments for patients with hepatocellular carcinoma (HCC) with a massive potential of long-term cure. However, it is disadvantaged by the relatively high rate of postoperative recurrence. In this study, a comparison was performed in the prognostic performance between albumin-bilirubin (ALBI) grade and Child-Pugh (C-P) grade for those HCC patients undergoing thermal ablation. METHODS: A total of 467 patients undergoing thermal ablation as the initial therapy were recruited and retrospectively analyzed. Then, an investigation was carried out into the prognostic values of overall survival (OS) and recurrence free survival (RFS) through ALBI grade and C-P score, separately. Besides, propensity-score matching (PSM) was performed to adjust the significantly different patient characteristics for ALBI grade based on C-P A patients. RESULTS: In the multivariate analysis, both ALBI and C-P grades were treated as independent prognostic factors for OS. Cox multivariate analysis was conducted to reveal that the independent risk factors for postoperative HCC recurrence included ALBI grade 2-3, multiple tumors, tumor size ≥2 cm, and age ≥65 years. Following PSM (1:1), both ALBI-1 and ALBI-2 groups were found to be well matched in all of the parameters involved. Depending on the ALBI grade (113 ALBI-1 vs. 113 ALBI-2), C-P A patients were reclassified into two risk groups for OS (P=0.0058) and RFS (P=0.012), respectively. CONCLUSIONS: The conventional C-P classification, despite its necessity, is less effective in assessing preoperative liver dysfunction for HCC patients and subjected to some limitations. Characterized by simplicity and objectivity, the ALBI grade has demonstrated its greater prognostic value than C-P grade for HCC patients who underwent thermal ablation.