Introduction Prognostic heterogeneity is common in patients with hepatocellular carcinoma (HCC) within the same clinical stage. While the albumin–bilirubin (ALBI) score and systemic immune-inflammation index (SII) have individual prognostic value, their combined significance remains unclear. We aimed to develop a novel ALBI-SII grade and a prognostic nomogram to refine risk stratification. Methods This retrospective study included 210 patients with HCC diagnosed between 2013 and 2021. A novel ALBI–SII grade was constructed by integrating ALBI and SII. Overall survival (OS) was analyzed using Kaplan–Meier methods and Cox regression based on a multiple imputation dataset. A nomogram incorporating ALBI–SII grade and China Liver Cancer (CNLC) staging was developed and validated using time-dependent ROC curves, DeLong’s test, and decision curve analysis (DCA). Results The ALBI–SII grade stratified patients into three distinct risk groups (Median OS: Grade 0, 639 days; Grade 1, 310 days; Grade 2, 148 days; P 0.001). In multivariate analysis, ALBI-SII grade remained an independent prognostic factor (Grade 2 vs. 0: HR = 2.576, 95% CI: 1.654–4.012, P 0.001). The 5-year AUC of ALBI-SII was 0.735, which was statistically comparable to that of CNLC staging (AUC = 0.724; DeLong’s P 0.05). The nomogram demonstrated robust discrimination (C-index: 0.695) and favorable clinical net benefit. Conclusion The ALBI–SII grade is an objective and practical prognostic indicator for HCC. A nomogram integrating ALBI–SII and CNLC staging provides reliable survival prediction, particularly for long-term outcomes.
Li et al. (Fri,) studied this question.