Albumin–Bilirubin (ALBI) Grade-Based Nomogram for Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization

Background/Aim: The prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is highly heterogeneous because of variable characteristics of tumor burden and liver dysfunction. We aimed to propose and validate an albumin–bilirubin (ALBI) grade-based prognostic nomogram for HCC patients undergoing TACE. Methods: A total of 1051 patients with HCC undergoing TACE were randomly assigned to derivation (n = 525) and validation (n = 526) set in this retrospective study based on prospective data. The multivariate Cox proportional hazards model in derivation set was used to generate the nomogram. The predictive accuracy of the nomogram was evaluated by discrimination and calibration tests. Results: In multivariate analysis, presence of ascites, ALBI grade 2–3, serum ɑ-fetoprotein level ≥ 400 ng/mL, total tumor volume ≥ 396 cm³, presence of vascular invasion, and poor performance status were independently associated with decreased survival of patients in the derivation set. Each patient had an individualized score from 0 to 41 by adding up the points from these six prognostic predictors. The nomogram generated from the derivation set had a concordance index of 0.72 (95% confidence interval [CI] 0.63–0.82). Discrimination test in the validation set provided a good concordance index 0.72 (95% CI 0.62–0.81), and the calibration plots consistently matched the ideal 45-degree reference line for 3- and 5-year survival prediction. Conclusions: The ALBI grade-based prognostic model can well discriminate the survival in HCC patients undergoing TACE. The proposed easy-to-use nomogram may accurately predict the survival at 3 and 5 years for individual HCC patient in the precision medicine era.