Prognostic role of the Child-Turcotte-Pugh classification and ALBI grade in patients without cirrhosis and hepatocellular carcinoma

BACKGROUND & AIMS: While the Child-Turcotte-Pugh (CTP) classification as well as the albumin-bilirubin (ALBI) grade represent important clinical tools for risk stratification in patients with cirrhosis and hepatocellular carcinoma (HCC), there is no data on the prognostic ability in patients without cirrhosis and HCC. METHODS: Cohort 1 included unresectable patients with HCC and BCLC stage A-C from the Medical University of Vienna and the Sorbonne University, Paris. Cohort 2 included patients with unresectable HCC treated with atezolizumab/bevacizumab or durvalumab/tremelimumab from two large international databases (AB-Real and DT-Real studies). We evaluated the prognostic value of the CTP classification/ALBI grade for overall survival (OS) by calculating Cox regression analyses as well as time-dependent AUROCs. RESULTS: Cohort 1 included 184 patients without cirrhosis (CTP-B: n=22/12.0%) and 1173 patients with cirrhosis (CTP-B: n=414/35.3%), and cohort 2 comprised 259 patients without cirrhosis (CTP B: n=19/7.3%) and 841 patients with cirrhosis (CTP-B: n=187/23.3%). CTP classification was independently associated with OS in cohorts 1 (aHR: 3.04 [95%CI: 1.70-5.45], p<0.001) and 2 (aHR: 3.24 [95%CI: 1.73-6.08], p<0.001), independent of BCLC stage and other relevant prognostic factors. Time-dependent AUROCs of CTP score were comparable at the analysed timepoints. Similar results were observed for ALBI grade. CONCLUSION: CTP classification and ALBI grade are associated with prognosis in patients without cirrhosis and HCC, and their prognostic power is comparable to that in patients with cirrhosis and HCC.

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Journal
JHEP Reports
Published
2026-10-01
DOI
https://doi.org/10.1016/j.jhepr.2026.102053
Primary Topic
Liver Disease and Transplantation
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article
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article

Prognostic role of the Child-Turcotte-Pugh classification and ALBI grade in patients without cirrhosis and hepatocellular carcinoma

David James Pinato, Haripriya Andanamala, Eleonora Alimenti, Najib Ben Khaled et al.
JHEP Reports
Liver Disease and Transplantation
article

Prognostic role of the Child-Turcotte-Pugh classification and ALBI grade in patients without cirrhosis and hepatocellular carcinoma

David James Pinato, Haripriya Andanamala, Eleonora Alimenti, Najib Ben Khaled, Calogero Cammà, Tiziana Pressiani, Amit G. Singal, Celina Ang, Francesca Salani, Tobias Meischl, Robin Kate Kelley, Kornelius Schulze, Antonio D’Alessio, Ciro Celsa, Katharina Pomej, Giuseppe Cabibbo, Rudolf E Stauber, Hidenori Toyoda, Alessandro Parisi, Johann von Felden, Naoshi Nishida, Fabio Piscaglia, Masatoshi Kudo, Caterina Vivaldi, Giulia Manfredi, Ilario Giovanni Rapposelli, Pasquale Lombardi, Susanna Varkey Ulahannan, Ahmed Omar Kaseb, Charles Roux, Bernhard Scheiner, Po Ting Lin, Leonardo Brunetti, Joe Eid, Claudia Angela Maria Fulgenzi, Matthias Pinter, Manon Allaire, Gianluca Masi, Lorenza Rimassa, Hong Jae Chon, Peter R. Galle, Beodeul Kang, Mario Pirisi, Chun‐Yen Lin, Bernardo Stefanini, Natascha Roehlen, Arndt Vogel, María Reig, Marta Fortuny, Michael A Trauner, Massimo Alberto Iavarone, Henning Wege, Marianna Silletta, Andrea Casadei‐Gardini, Andrea Dalbeni, Anja Krall, Lorenz Balcar, Wei‐Fan Hsu, Yi‐Hsiang Huang, Ashwini Arvind, Ahmer Adnan, Sarah Mouri, Pei-Chang Lee, Abelina Kreuter, Anwar Saeed, Iakow Bolnykh, Michael Li
article en

Abstract

BACKGROUND & AIMS: While the Child-Turcotte-Pugh (CTP) classification as well as the albumin-bilirubin (ALBI) grade represent important clinical tools for risk stratification in patients with cirrhosis and hepatocellular carcinoma (HCC), there is no data on the prognostic ability in patients without cirrhosis and HCC. METHODS: Cohort 1 included unresectable patients with HCC and BCLC stage A-C from the Medical University of Vienna and the Sorbonne University, Paris. Cohort 2 included patients with unresectable HCC treated with atezolizumab/bevacizumab or durvalumab/tremelimumab from two large international databases (AB-Real and DT-Real studies). We evaluated the prognostic value of the CTP classification/ALBI grade for overall survival (OS) by calculating Cox regression analyses as well as time-dependent AUROCs. RESULTS: Cohort 1 included 184 patients without cirrhosis (CTP-B: n=22/12.0%) and 1173 patients with cirrhosis (CTP-B: n=414/35.3%), and cohort 2 comprised 259 patients without cirrhosis (CTP B: n=19/7.3%) and 841 patients with cirrhosis (CTP-B: n=187/23.3%). CTP classification was independently associated with OS in cohorts 1 (aHR: 3.04 [95%CI: 1.70-5.45], p<0.001) and 2 (aHR: 3.24 [95%CI: 1.73-6.08], p<0.001), independent of BCLC stage and other relevant prognostic factors. Time-dependent AUROCs of CTP score were comparable at the analysed timepoints. Similar results were observed for ALBI grade. CONCLUSION: CTP classification and ALBI grade are associated with prognosis in patients without cirrhosis and HCC, and their prognostic power is comparable to that in patients with cirrhosis and HCC.

JHEP Reports
Università Cattolica del Sacro Cuore (IT), University of Pisa (IT), University of Verona (IT), Marche Polytechnic University (IT), Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT), Mount Sinai Hospital (US), Humanitas University (IT), The University of Texas MD Anderson Cancer Center (US), University of Kansas (US), Vita-Salute San Raffaele University (IT), Università Campus Bio-Medico (IT), Universität Hamburg (DE), University of Freiburg (DE), Chang Gung University (TW), University of California, San Francisco (US), China Medical University (TW), Medical University of Graz (AT), University Medical Center Freiburg (DE), Agostino Gemelli University Polyclinic (IT), Taipei Veterans General Hospital (TW), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), LMU Klinikum (DE), Chang Gung Memorial Hospital (TW), Medizinische Hochschule Hannover (DE), Sorbonne Université (FR), University Medical Center of the Johannes Gutenberg University Mainz (DE), Azienda Ospedaliera Universitaria Integrata Verona (IT), IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT), Assistance Publique – Hôpitaux de Paris (FR), The University of Kansas Cancer Center (US), Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IT), University Medical Center Hamburg-Eppendorf (DE), Azienda Ospedaliero Universitaria Ospedali Riuniti (IT), Linkou Chang Gung Memorial Hospital (TW), Pitié-Salpêtrière Hospital (FR), Ogaki Municipal Hospital (JP), China Medical University Hospital (TW), Marienkrankenhaus Hamburg (DE), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES), IRCCS Ospedale San Raffaele (IT), CHA University Bundang Medical Center (KR), Campus Bio Medico University Hospital (IT), CHA University (KR), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera Universitaria Pisana (IT), UCSF Helen Diller Family Comprehensive Cancer Center (US), Tisch Cancer Institute, OU Health Stephenson Cancer Center, Imperial College London (GB), University of Oklahoma Health Sciences Center (US), Medical University of Vienna (AT), Ludwig-Maximilians-Universität München (DE), The University of Texas Southwestern Medical Center (US), University of Palermo (IT), Kindai University (JP)
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