To compare the prognostic value between Child-Pugh score and albumin-bilirubin (ALBI) grading for patients with BCLC-B stage hepatocellular carcinoma (HCC).

Clinical data of 173 patients with BCLC-B stage HCC admitted to the Second Affiliated Hospital of Air Military Medical University from January 2010 to December 2014 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 156 patients were male and 17 females, aged (59±12) years on average. All patients were treated with microwave ablation-assisted hepatectomy and postoperative TACE. Child-Pugh score and ALBI grade of the patients were calculated. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The prognostic risk factors were identified by Cox regression model. The prognostic value of two score system were evaluated by using time-dependent receiver operating characteristic (ROC) curve and C-index.

The 1-, 3- and 5-year cumulative survival rates of patients with a Child-Pugh score of 5 were 87.7%, 59.3% and 31.4%, respectively, and were 76.1%, 36.4% and 25.2% in patients with Child-Pugh score of 6, where significant difference was observed (χ²=5.004, P<0.05). The 1-, 3- and 5-year cumulative survival rates of patients with ALBI grade 1 were 92.2%, 73.7%, and 53.7%, and were 74.5%, 32.0%, and 15.0% in those with ALBI grade 2, where significant difference was observed (χ²=20.415, P<0.05). Cox multivariate analysis showed that Child-Pugh score and ALBI grade were the independent risk factors for the survival and prognosis of HCC patients (HR=1.559, 2.947; P<0.05). The C-index of ALBI grade was 0.64, while it was 0.58 for Child-Pugh score. The predictive ability of ALBI grade was higher than that of Child-Pugh score.

Compared with Child-Pugh score, ALBI grade yields a better predictive ability for the survival and prognosis of BCLC-B stage HCC patients undergoing microwave ablation-assisted hepatectomy and postoperative TACE.