Combining albumin‐bilirubin score with future liver remnant predicts post‐hepatectomy liver failure in HBV‐associated HCC patients

Background and Aims Accurate assessment of liver functional reserve pre‐operatively is vital for safe hepatic resection. The ALBI score is a new model for assessing liver function. This study aimed to evaluate the value of combining ALBI score with sFLR in predicting post‐operative morbidity and PHLF in HCC patients who underwent hepatectomy. Methods Patients undergoing three‐dimensional CT reconstruction prior to hepatectomy for HCC between January 2015 and January 2017 were enrolled. The values of the CP score, ALBI score and sFLR in predicting post‐operative outcomes were evaluated. Results A total of 229 HCC patients were enrolled; 24 (10.5%) experienced major complications and 21 (9.2%) developed PHLF. The incidence of major complications and PHLF increased with increasing ALBI grade. The ALBI grade classified patients with CP grade A into two subgroups with different incidences of PHLF (P=.029). sFLR and ALBI scores were identified as independent predictors of PHLF. The AUC values for the CP score, ALBI score, sFLR and sFLR×ALBI for predicting major complications were 0.600, 0.756, 0.660 and 0.790 respectively. The AUC values of the CP score, ALBI score, sFLR and sFLR×ALBI for predicting PHLF were 0.646, 0.738, 0.758 and 0.884 respectively. Conclusions The ALBI score showed superior predictive value of post‐operative outcomes over CP score, and the combination of sFLR and ALBI score was identified as a stronger predictor of post‐operative outcomes than the sFLR or ALBI score alone.