The Combined ALBI-FIB-4 Score for Prognostic Stratification in Hepatocellular Carcinoma: A Single Center Retrospective Study.

Background: Hepatocellular carcinoma (HCC) is influenced not only by tumor burden but also by liver function and the extent of fibrosis. Although the albumin-bilirubin (ALBI) score and the fibrosis-4 (FIB-4) index are validated independent predictors, their combined prognostic impact has been insufficiently examined. Methods: We retrospectively analyzed 307 patients with HCC diagnosed between 2002 and 2025. ALBI and FIB-4 scores were calculated at baseline, and a composite score was generated using the β-coefficients obtained from a multivariable Cox regression model, allowing each component to contribute proportionally to its prognostic weight (combined score = 0.503 × ALBI + 0.0576 × FIB-4). Patients were stratified using the median cutoff value (-0.95). Outcomes included overall survival (OS), event-free survival (EFS) for those undergoing locoregional therapies, and progression-free survival (PFS) for patients treated with systemic therapy. Results: Median OS was 12.1 months. Patients with combined scores ≤-0.95 had superior OS (18.3 vs 6.8 months, p < 0.001), and the score remained an independent predictor of OS (HR 2.01, 95% CI 1.48-2.72, p = 0.001). In the locoregional therapy group, lower scores predicted improved EFS (16.4 vs 5.8 months,: HR:1.86; 95% CI:1.17-2.96; p=0.009). Among systemic therapy patients, the combined score independently predicted PFS (HR 1.70, 95% CI 1.21-2.41, p = 0.021). Conclusion: The combined ALBI-FIB-4 score is an accessible and reproducible prognostic marker across therapeutic settings in HCC. By integrating measures of hepatic reserve and fibrosis, it provides additional prognostic granularity beyond tumor-centric staging systems. These findings highlight its potential utility in personalized risk stratification and warrant validation in prospective, multi-ethnic cohorts.