Role of ALBI Grade as a Predictive Factor for Long-Term Mortality in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Background: This study investigated the role of the albumin–bilirubin (ALBI) grade as a predictive factor for mortality in patients with favorable liver function undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods: A total of 251 HCC patients with Child–Pugh class A and a model for end-stage liver disease (MELD) score < 10 who received TACE as initial treatment were analyzed. Predictive factors for overall survival were assessed. Results: The mean age was 61.5 years, and the median follow-up was 10.3 years. A high ALBI grade (ALBI score > −2.60) was observed in 147 patients (59%). Multivariable analysis showed that mortality was significantly associated with Barcelona Clinic Liver Cancer (BCLC) stage B (hazard ratio [HR] 2.21, 95% confidence interval [CI] 1.24–3.93, p = 0.007), BCLC stage C (HR 4.80, 95% CI 2.76–8.34, p < 0.001), presence of ascites (HR 2.28, 95% CI 1.31–3.97, p = 0.003), progressive disease (PD) of tumor response (HR 2.95, 95% CI 1.76–4.93, p < 0.001), and high ALBI grade (Grade ≥ 2) (HR 1.96, 95% CI 1.20–3.21, p = 0.008). Overall survival differed significantly by ALBI grade: the 3-, 6-, 9-, and 12-year survival rates were 80.4%, 78.7%, 76.2%, and 65.5% in the low ALBI group (Grade 1) and 61.3%, 42.8%, 35.7%, and 35.7% in the high ALBI group (Grade ≥ 2) (p < 0.001). Conclusions: High ALBI grade (Grade ≥ 2) is associated with increased mortality in patients with Child–Pugh class A and low MELD score undergoing TACE for HCC. ALBI grade may serve as a predictor of survival in patients with preserved liver function receiving TACE.