Prognostic value of albumin-bilirubin grade in patients with pancreatic cancer: A systematic review and meta-analysis.

BACKGROUND

With a five-year survival rate near 10%, pancreatic cancer is among the cancers with poor survival. Understanding the prognostic factors provides clinical insights for better decision-making. This meta-analysis aims to assess the prognostic value of the albumin-bilirubin (ALBI) grade in patients with pancreatic cancer.

METHOD: A comprehensive search using "pancreatic cancer" and "ALBI grade" as keywords was conducted on the PubMed, Web of Science, Embase and Scopus until August 14, 2025. Studies investigating the prognostic value of the ALBI grade in patients with pancreatic cancer were included. The prognostic value was assessed through the hazard ratio (HR) with a 95% confidence interval (95% CI). The meta-analysis was performed using R version 4.2.3.

RESULTS

The meta-analysis comprised six studies with 1665 patients for overall survival (OS) analysis and three studies with 936 patients for recurrence-free survival/disease-free survival (RFS/DFS). A higher ALBI grade was associated with decreased OS in patients with pancreatic cancer (HR = 2.14, 95% CI [1.53, 3.00]). A higher ALBI grade was associated with decreased RFS/DFS (HR = 2.39, 95% CI [1.02, 5.58]). A sub-group analysis based on ALBI grade revealed that no significant differences between different grading approaches (high vs. low, 2 vs. 1 and 3 vs. 1) were observed in predicting OS.

CONCLUSION

A higher ALBI grade was significantly associated with decreased OS and RFS/DFS in patients with pancreatic cancer. The ALBI grade could be considered a reliable prognostic marker for clinical applications in patients with pancreatic cancer.