Prognostic Value of PALBI in Patients With Hepatocellular Carcinoma and Concurrent Chronic Kidney Disease: A Nomogram Development

AIM: Prognosis in hepatocellular carcinoma (HCC) depends not only on tumor burden but also on liver function and comorbidities, particularly chronic kidney disease (CKD). Although several prognostic models exist, their performance in patients with HCC and CKD has not been systematically evaluated. This study compared the predictive accuracy of liver-specific models and developed a nomogram for individualized survival prediction. METHODS: We conducted a nationwide multicenter cohort study of 1201 treatment-naive patients newly diagnosed with HCC and concurrent CKD. Prognostic performance for overall survival was assessed for Child-Pugh, MELD, MELD-Na, MELD 3.0, ALBI, and PALBI scores. RESULTS: The mean age was 70.4 ± 10.7 years, and 72.6% were male. Over a mean follow-up of 37.8 months, 1017 deaths occurred with an incidence rate of 269.1 per 1000 person-years. Among prognostic models, PALBI showed favorable discriminative ability with area under the receiver operating characteristic curve values of 0.871, 0.857, and 0.833 at 3, 6, and 12 months, respectively. Concordance index values were generally comparable among the models, with the PALBI-based model demonstrating consistent and reliable performance across most clinical subgroups. A nomogram incorporating age, AFP, CKD stage, BCLC stage, treatment modality, and PALBI grade provided individualized survival estimates with good calibration. CONCLUSIONS: In patients with HCC and CKD, PALBI showed comparable prognostic performance to other liver-specific models, while maintaining clinical applicability based exclusively on objective laboratory parameters. The proposed nomogram, integrating PALBI with clinical and tumor factors, may serve as a practical tool to support personalized risk stratification and treatment decision-making in this complex population.