Preoperative ALBI and APRI are independently associated with liver-related complications after curative-intent hepatectomy.

BACKGROUND

Accurate preoperative risk stratification remains essential for patients undergoing curative-intent hepatectomy for intrahepatic cholangiocarcinoma (iCCA) or hepatocellular carcinoma (HCC). Although the albumin-bilirubin (ALBI) score and AST-to-platelet ratio index (APRI) reflect hepatic reserve and fibrosis burden, respectively, their complementary value for predicting liver-related complications across primary liver malignancies remains poorly defined.

METHODS

A retrospective multi-institutional cohort study included 2668 patients who underwent curative-intent hepatic resection for iCCA or HCC (2000-2023). Multivariable logistic regression evaluated associations of ALBI and APRI with liver-related complications, post-hepatectomy liver failure (PHLF), and major complications. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with bootstrap internal validation.

RESULTS

Among 2668 patients, 392 (14.7%) developed liver-related complications. Both ALBI (OR 1.65, 95% CI 1.28-2.12) and APRI (OR 1.18, 95% CI 1.05-1.33) were independently associated with liver-related complications. The combined model achieved an AUC of 0.740 (optimism-corrected 0.733). ALBI and APRI also demonstrated differential associations across endpoints, with APRI more strongly associated with PHLF and ALBI more strongly associated with major complications.

DISCUSSION: Preoperative ALBI and APRI were independently associated with liver-related complications after hepatectomy for iCCA and HCC, reflecting hepatic reserve and fibrosis-related injury.