Prognostic value of albumin-bilirubin grade in patients with cholangiocarcinoma: a systematic review and meta-analysis.

Background: Cholangiocarcinoma (CCA) is a type of cancer that develops in the biliary tract. CCA accounts for 10% of primary hepatic cancers and is characterized by its aggressive nature and poor prognosis. This systematic review and meta-analysis aims to assess the prognostic value of the novel hepatic function assessment measure known as albumin-bilirubin (ALBI) grade in patients with CCA.
Method: A comprehensive search was conducted on PubMed, Web of Science, Embase, and Scopus databases until August 11, 2023. Studies examining the prognostic impact of ALBI grade in patients with CCA were included. The prognostic effect was evaluated using hazard ratio (HR) with 95% confidence intervals (CI). The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The final meta-analysis was performed using R version 4.3.1.
Results: The final meta-analysis included 13 studies with 3,434 patients. In univariate analysis (HR = 1.90, 95% CI: 1.65-2.19, P < 0.01) and multivariate analysis (HR = 1.88, 95% CI: 1.41-2.52, P < 0.01), higher ALBI grade was associated with lower overall survival (OS) in patients with intrahepatic CCA (ICCA). Higher ALBI grade was also correlated with decreased recurrence-free survival (RFS), with an HR of 1.63 (95% CI: 1.36-1.97, P < 0.01). Subgroup analysis of different ALBI grade comparisons showed consistent findings with our pooled data.
Conclusion: A high ALBI grade indicates poor OS and RFS in patients with CCA especially intrahepatic type. ALBI should be considered a reliable and clinically useful prognostic indicator.
Registration: PROSPERO ID: CRD42022379877.
Competing Interests: Declarations. Ethics and approval and consent to participant: As a systematic review and meta-analysis, our study did not require any human participation and, referral to our ethics committee. Consent for publication: Not applicable. Competing of interest: All authors declare no competing of interest.
(© 2025. The Author(s).)