Prognostic Impact of Albumin Bilirubin Score In Patients Undergoing Surgery for Perihilar Cholangiocarcinoma.

BACKGROUND/AIM: The Albumin-Bilirubin (ALBI) score was initially developed to estimate prognosis in patients with hepatocellular carcinoma. Recently, its prognostic relevance has been extended to intrahepatic cholangiocarcinoma; however, its impact on perihilar cholangiocarcinoma remains unclear.

PATIENTS AND

METHODS

A total of 71 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2007 and 2024 at Jichi Medical University were retrospectively analyzed. Preoperative blood samples were obtained within two weeks before surgery, after effective jaundice control. Survival outcomes were evaluated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for overall survival.

RESULTS

Patients with ALBI Grade 1 had a significantly longer median survival time compared to those with ALBI Grade 2 or 3 (not reached vs. 45 months vs. 13 months, respectively; p=0.001). The prognostic nutritional index (PNI) was significantly lower in ALBI Grade 2/3 than in Grade 1 (41.6±5.7 vs. 49.5±5.9, p<0.001). Similarly, carbohydrate antigen 19-9 (CA19-9) levels were higher in ALBI Grade 2/3 compared to Grade 1 (493±129 vs. 98±176 U/mL, p=0.002). Multivariable analysis identified ALBI Grade 2/3 as an independent negative prognostic factor for overall survival (HR=2.14, 95% CI=1.01-4.54, p=0.047). Regression analysis showed a strong inverse correlation between ALBI score and serum albumin levels (R=-0.9624, p=0.001).

CONCLUSION

ALBI score may provide valuable prognostic information for long-term outcomes in patients undergoing hepatectomy for perihilar cholangiocarcinoma.