S2920 Role of Albumin-Bilirubin (ALBI) Score in Predicting Post-Hepatectomy Outcomes in Patients With Hepatocellular Carcinoma: A Systemic Review and Meta-Analysis

Introduction: Hepatocellular carcinoma (HCC) is one of the major cause of cancer-related mortality globally, with hepatectomy being a curative option for selected patients. Guidance of postoperative treatment is achieved through preoperative prediction of accurate prognostication following surgery. The Albumin-Bilirubin (ALBI) score, a simple and objective indicator of liver function, has been proposed as a potential prognostic marker. However, its predictive value in patients undergoing hepatic resection for HCC remains uncertain. In this meta-analysis, we aimed to evaluate the prognostic role of the ALBI score in predicting post-hepatectomy outcomes in patients with HCC using the pooled data. Methods: A systematic search of PubMed/MEDLINE and the Cochrane Library databases was conducted. Studies assessing the ALBI score as a prognostic factor in HCC patients undergoing curative hepatectomy were included. Out of an initial 28 articles identified, 11 studies fulfilled the inclusion criteria and were incorporated into the final meta-analysis. The outcomes analyzed included overall survival (OS), recurrence-free survival (RFS), prediction of microvascular invasion (MVI), and prediction of post-hepatectomy liver failure (PHLF). Results: Among the 11 included studies, 7 studies evaluated the ALBI score's role in predicting overall survival, and 6 studies investigated its association with recurrence-free survival. One study assessed the ALBI score’s predictive value for microvascular invasion, and another evaluated its ability to predict post-hepatectomy liver failure. The pooled analysis demonstrated that a higher ALBI grade was significantly associated with poorer overall survival and increased recurrence rates following hepatectomy. Moreover, a higher ALBI score correlated with the presence of microvascular invasion and higher rates of post-hepatectomy liver failure, reinforcing its role as a reliable prognostic biomarker. Conclusion: The ALBI score is a valuable, non-invasive tool for predicting postoperative prognosis in patients with HCC undergoing hepatic resection. Higher ALBI grades are significantly associated with poorer overall survival, increased risk of recurrence, microvascular invasion, and post-hepatectomy liver failure.