Simple Summary:
The survival of patients with hepatocellular carcinoma (HCC) is highly variables,
due to heterogeneous tumor burden and liver dysfunction. Tumor burden score (TBS) is a continuous
variable to measure the extent of tumor involvement, and the albumin–bilirubin (ALBI) grade is
an objective model to estimate hepatic functional reserve. Six prognostic predictors—including
TBS, ALBI grade, ascites, serum α-fetoprotein level, vascular invasion or distant metastasis, and
performance status—were linked with survival in a multivariate Cox model. We used these predictors
to establish a new prognostic model—the TBS–ALBI system—to predict patient outcomes. Significant
survival differences were found in different TBS–ALBI scores in the derivation and validation cohorts.
This new system can also discriminate survival differences in patients with different viral etiologies,
cancer stages, and treatment modalities. This study shows that the TBS–ALBI system is a feasible and
user-friendly prognostic model for HCC.
Abstract:
The prognosis of hepatocellular carcinoma (HCC) varies widely due to variable tumor
extent and liver reserve. We aimed to develop and validate a new prognostic model based on tumor
burden score (TBS) and albumin–bilirubin (ALBI) grade for HCC. We prospectively identified 3794
HCC patients who were randomized into derivation and validation groups. Survival predictors were
evaluated by a multivariate Cox model. The TBS–ALBI system allocated two points for high TBS
and ALBI grade 3, and one point each for the presence of ascites, serum α-fetoprotein ≥ 400 ng/mL,
vascular invasion or distant metastasis, performance status 2–4, medium TBS, and ALBI grade 2, with
a maximal score of 8 points. Significant survival differences were found across different TBS–ALBI
score groups in the validation cohort (all p < 0.001). The TBS–ALBI system had the lowest corrected
Akaike information criterion (AICc) and the highest homogeneity compared with other proposed
staging models. The discriminative ability of the TBS–ALBI system was consistently stable across
different viral etiologies, cancer stages, and treatment strategies. Conclusions: This new TBS–ALBI
system is a feasible and robust prognostic system in comparison with other systems; it is a userfriendly tool for long-term outcome assessment independent of treatment modality and cancer stage
in HCC.