Validation of Modified Albumin‐Bilirubin‐Tumor Stage as a Prognostic Model in Early‐Stage Hepatocellular Carcinoma Treated With Radiofrequency Ablation

Survival after radiofrequency ablation (RFA) for very early- or early-stage hepatocellular carcinoma (HCC) remains heterogeneous because prognosis depends on both tumor burden and hepatic reserve. We retrospectively evaluated treatment-naive patients with Barcelona Clinic Liver Cancer (BCLC) Stages 0 or A HCC treated with RFA as initial therapy from January 2002 to September 2016. Patients with Child-Pugh class A or B and complete ablation were included. Four prespecified total scores, Child-Pugh-tumor (CP-T), albumin-bilirubin-tumor (ALBI-T), modified ALBI-tumor (mALBI-T), and platelet-ALBI-tumor (pALBI-T) were compared using the Akaike information criterion (AIC), Harrell concordance index (C-index), time-dependent area under the receiver operating characteristic curve, calibration, and subgroup analyses. Of 1238 patients screened, 950 were included; 831 (87.5%) were Child-Pugh class A. During a median follow-up of 5.44 years, 417 deaths occurred; 5- and 10-year overall survival rates were 58.0% and 35.8%, respectively. The American Joint Committee on Cancer eighth-edition T stage illustrated the best tumor-stage performance and was used in the total scores, while mALBI-T had the lowest AIC (5052.2) and highest Harrell C-index (0.628; 95% confidence interval, 0.601-0.655). Paired bootstrap differences versus CP-T, ALBI-T, and pALBI-T were statistically significant, but modest, while mALBI-T performed best at 5 years and in Child-Pugh class A patients, whereas all models showed limited discrimination in Child-Pugh class B patients. Apparent calibration was generally close, and mALBI-T also had the best fit for recurrence-free survival. mALBI-T provides a simple prognostic model for long-term survival stratification after complete ablation in early-stage hepatocellular carcinoma, especially in Child-Pugh class A patients.