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Cong LY, Ma LY, Hong X, Geng GL, Fan BF. Construction and validation of a prognostic prediction model based on albumin-bilirubin grade after resection of hepatocellular carcinoma. World J Gastrointest Surg 2026; 18(11): 122279 [DOI: 10.4240/wjgs.122279]
World J Gastrointest Surg. Nov 27, 2026; 18(11): 122279 Published online Nov 27, 2026. doi: 10.4240/wjgs.122279
Construction and validation of a prognostic prediction model based on albumin-bilirubin grade after resection of hepatocellular carcinoma
Lu-Yi Cong, Ling-Yu Ma, Xin Hong, Gui-Ling Geng, Ben-Fang Fan
Lu-Yi Cong, Ling-Yu Ma, DSA Operating Room, Affiliated Nantong Clinical College of Nantong University, Nantong First People’s Hospital, Nantong 226000, Jiangsu Province, China
Xin Hong, Department of Intervention, Affiliated Nantong Clinical College of Nantong University, Nantong First People’s Hospital, Nantong 226000, Jiangsu Province, China
Gui-Ling Geng, School of Nursing, Nantong University, Nantong 226000, Jiangsu Province, China
Ben-Fang Fan, Department of Nursing, Affiliated Nantong Clinical College of Nantong University, Nantong First People’s Hospital, Nantong 226000, Jiangsu Province, China
Author contributions: Cong LY conceived and designed the research, acquired data, performed statistical analysis, obtained funding, and drafted the manuscript; Geng GL contributed to data acquisition and critically revised the manuscript for important intellectual content; Hong X participated in data analysis and interpretation and assisted in securing funding; Fan BF and Ma LY contributed to data analysis, interpretation, and statistical analysis. All authors read and approved the final manuscript.
AI contribution statement: No AI tools were employed in the preparation of this manuscript. All content was written solely by the authors.
Supported by Nantong Municipal Health Research Project, No. QNZ2024017 and No. MS2022019.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Nantong First People’s Hospital (approval No. 2026-KT024-02).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Ben-Fang Fan, Chief Nurse, Department of Nursing, Affiliated Nantong Clinical College of Nantong University, Nantong First People’s Hospital, No. 666 Shengli Road, Chongchuan District, Nantong 226000, Jiangsu Province, China. fanbenfang26@163.com
Received: May 29, 2026 Revised: June 29, 2026 Accepted: July 28, 2026 Published online: November 27, 2026 Processing time: 176 Days and 18.3 Hours
Abstract
BACKGROUND
Hepatocellular carcinoma (HCC) is one of the world's major health problems and high recurrence after curative resection limits long-term survival. Existing prognostic tools, such as Child-Pugh score, are limited by subjective aspects. Albumin-bilirubin (ALBI) grade (objective lab parameters) is shown to have an advantage in assessing liver function and prognosis. Given the limitations of existing prognostic tools and the proven prognostic value of ALBI grade in HCC, there is a need to develop an integrated, objective prediction model for postoperative recurrence risk stratification.
AIM
To construct and validate a prognostic prediction model based on ALBI grade after HCC resection.
METHODS
We looked back at clinical data from 596 patients with HCC who had a radical hepatectomy from 2021 to 2023. Using Kaplan-Meier analysis and Cox regression, we identified independent predictors of recurrence-free survival (RFS). We then built a nomogram that combines these predictors to estimate 1- and 2-year RFS.
RESULTS
In the ALBI 2/3 group, the median RFS was 20.0 months. While the median RFS in the ALBI level 1 group was not reached at the end of the study, the differences between the two groups were statistically significant (P < 0.001). Multifactor Cox regression analysis showed that ALBI score, age, tumor size, tumor number, and alpha-fetoprotein levels were independent predictors of the effect on RFS (P < 0.05). We built nomogram with a consistency index (C-index) of 0.647 in the training set and 0.643 in the validation set. From the results of the time dependency analysis, area under the curve was 0.638-0.676 in the 1- and 2-year RFS predictions.
Core Tip: We proposed and validated a new predictive tool, the nomogram, to assess whether patients with hepatocellular carcinoma will experience recurrence and how long they will live after radical surgery. This tool uses the level of bilirubin (commonly known as albumin-bilirubin). At the same time, it also combines known tumor indicators such as age, tumor size, number of tumors, and levels of alpha-fetoprotein. In this way, we can provide each patient with a more personalized and clinically relevant risk stratification, helping physicians better develop postoperative plans for patient monitoring and treatment.
