The clinical utility of serum prealbumin levels as a prognostic marker in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization: a meta-analysis of 2,996 patients

Introduction Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally. Transarterial chemoembolization (TACE) is key for unresectable HCC, but patient outcomes vary, necessitating reliable prognostic markers. Although preoperative serum prealbumin (PAB) reflects nutrition and liver function and shows prognostic potential in single-center studies, high-level evidence is lacking. This meta-analysis aimed to systematically confirm the prognostic value of baseline serum PAB in HCC patients undergoing TACE. Materials and methods Relevant publications up to February 3, 2026, were retrieved from PubMed, The Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, and CBM databases. Fixed-effect or random-effects models were used to calculate the pooled hazard ratio (HR) for overall survival (OS) and odds ratio (OR) for clinicopathological characteristics associated with serum PAB. Sensitivity and subgroup analyses investigated heterogeneity and assessed result stability. Publication bias analysis was conducted to evaluate the reliability of the meta-analysis findings. Results Eight datasets from five studies were analyzed. Lower baseline PAB was significantly associated with poorer OS (pooled HR for high vs. low PAB = 0.64, 95% CI: 0.59–0.70, P<0.0001; random-effects model, I 2 = 0%). Higher PAB correlated with favorable features: earlier BCLC stage (OR = 2.23), better Child-Pugh class (OR = 5.36), absence of vascular invasion (OR = 0.44) or extrahepatic metastasis (OR = 0.22), smaller tumor size (OR = 0.51), single tumor (OR = 1.39), and lower AFP (OR = 0.56) (all P<0.05 except single tumor P = 0.020 and AFP P = 0.006). No significant association was found between prealbumin level and hepatitis B virus (HBV) infection status (P = 0.630). Subgroup and sensitivity analyses supported these findings, with no significant publication bias. Conclusion The analysis of 2,996 patients confirms that lower baseline serum PAB is significantly associated with poorer OS and unfavorable clinicopathological features in HCC patients receiving TACE. Further prospective and multi-center studies are needed to validate its clinical utility.