Application of the albumin-bilirubin grade for predicting prognosis after curative resection of patients with early-stage hepatocellular carcinoma

•ALBI grade was an independent predictor of OS for patients with early-stage HCC.•The ALBI grade successfully reclassified the C-P grade.•The ALBI grade was clinically significant for the AFP-negative subgroup.

BackgroundPatients with Barcelona Clinic Liver Cancer (BCLC) 0 + A are considered to have early-stage hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) grade is a significant predictor of overall survival (OS) for HCC. However, data are lacking to support its significance for patients with early-HCC.MethodsWe recruited 318 patients with early-HCC who underwent curative resection between January 2012 and August 2013. The Kaplan–Meier method and log-rank tests were used to compare OS of patients with different ALBI grades. Cox regression analysis was applied to evaluate ALBI grade as an independent predictor of OS.ResultsEarly-HCC patients with ALBI grade II experienced significantly shorter OS (p < 0.001) and higher death rates. In the Child-Pugh (C-P) grade-A group, patients with ALBI grade I had a more favorable prognosis than those with grade II (p < 0.001), while the C-P grade did not distinguish patients with poor prognosis from the entire group. Cox regression analysis demonstrated that ALBI grade was the most significant independent predictor of OS, and the ALBI grade retained its clinical significance in low α-fetoprotein subgroup.ConclusionALBI grade predicted OS in patients with early-HCC. Reclassification of C-P grade according to ALBI grade might improve the management of HCC.