Combined neutrophil-to-lymphocyte ratio and albumin-bilirubin grade predict survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Clinical outcomes after transarterial chemoembolization (TACE) vary considerably among patients with hepatocellular carcinoma (HCC), reflecting the heterogeneity of both tumor biology and underlying liver function. Although systemic inflammatory markers and liver functional reserve have individually been associated with prognosis, the clinical utility of their combined assessment remains unclear. We investigated the prognostic value of combining the neutrophil-to-lymphocyte ratio (NLR) and albumin-bilirubin (ALBI) grade in treatment-naïve patients with HCC undergoing initial TACE. We retrospectively analyzed 642 treatment-naïve patients with HCC who received TACE as first-line therapy. Overall survival (OS) was evaluated using the Kaplan–Meier method and Cox proportional hazards regression. Independent prognostic factors were identified by multivariable analysis. Receiver operating characteristic (ROC) curve analysis was performed to compare the prognostic performance of NLR, ALBI grade, and their combination. During a median OS duration of 41 months, 485 patients (75.5%) died. Multivariable analysis identified Barcelona Clinic Liver Cancer (BCLC) stage (HR 2.070, 95% CI 1.477–2.902; P < 0.001), ALBI grade (HR 1.630, 95% CI 1.248–2.128; P < 0.001), and NLR (HR 1.623, 95% CI 1.195–2.205; P = 0.002) as independent predictors of OS. The combination of ALBI grade and NLR demonstrated modestly improved prognostic discrimination (AUC 0.645) compared with ALBI grade alone (AUC 0.610) or NLR alone (AUC 0.576). Patients with both elevated NLR and impaired liver function exhibited significantly poorer long-term survival than all other subgroups ( P < 0.001). The combination of ALBI grade and NLR provides a simple and readily available prognostic tool that integrates liver functional reserve and systemic inflammatory status. This combined marker improves risk stratification and may serve as a complementary tool for prognostic assessment and clinical decision-making.