ALBI-SII grade: a novel prognostic indicator superior to Child–Pugh score for long-term survival in hepatocellular carcinoma and its nomogram construction and validation

Introduction: Prognostic heterogeneity is common in patients with hepatocellular carcinoma (HCC) within the same clinical stage. While the albumin-bilirubin (ALBI) score and systemic immune-inflammation index (SII) have individual prognostic value, their combined significance remains unclear. We aimed to develop a novel ALBI-SII grade and a prognostic nomogram to refine risk stratification. Methods: This retrospective study included 210 patients with HCC diagnosed between 2013 and 2021. A novel ALBI-SII grade was constructed by integrating ALBI and SII. Overall survival (OS) was analyzed using Kaplan-Meier methods and Cox regression based on a multiple imputation dataset. A nomogram incorporating ALBI-SII grade and China Liver Cancer (CNLC) staging was developed and validated using time-dependent ROC curves, DeLong's test, and decision curve analysis (DCA). Results: The ALBI-SII grade stratified patients into three distinct risk groups (Median OS: Grade 0, 639 days; Grade 1, 310 days; Grade 2, 148 days; P < 0.001). In multivariate analysis, ALBI-SII grade remained an independent prognostic factor (Grade 2 vs. 0: HR = 2.576, 95% CI: 1.654-4.012, P < 0.001). The 5-year AUC of ALBI-SII was 0.735, which was statistically comparable to that of CNLC staging (AUC = 0.724; DeLong's P > 0.05). The nomogram demonstrated robust discrimination (C-index: 0.695) and favorable clinical net benefit. Conclusion: The ALBI-SII grade is an objective and practical prognostic indicator for HCC. A nomogram integrating ALBI-SII and CNLC staging provides reliable survival prediction, particularly for long-term outcomes.