ALBI-SII grade: a novel prognostic indicator superior to Child–Pugh score for long-term survival in hepatocellular carcinoma and its nomogram construction and validation

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.