Abstract
BACKGROUND: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality. Surgical resection offers a curative option, but outcomes vary widely. Accurate preoperative risk stratification is essential. This study evaluated the prognostic value of the albumin-bilirubin (ALBI) score and triglyceride-glucose (TyG) index-markers of liver function and metabolic status-in patients undergoing curative liver resection. METHODS: This retrospective study included 238 patients with pathologically confirmed HCC who underwent curative liver resection. Preoperative clinical and biochemical variables were collected, and a prognostic model was developed using the entire dataset. Multivariate Cox proportional hazards regression was performed to identify independent prognostic factors. A nomogram incorporating the ALBI score and TyG index was constructed to estimate 2-, 3-, and 4-year overall survival (OS). Model performance was assessed through Kaplan-Meier survival analysis, receiver operating characteristic (ROC) curves, calibration plot, and decision curve analysis (DCA). Bootstrap resampling was used for internal validation to generate corrected estimates of model accuracy. RESULTS: Multivariate Cox regression demonstrated that both the ALBI score [hazard ratio (HR) =5.120; 95% confidence interval (CI): 2.944-8.905; P<0.001] and the TyG index (HR =4.202; 95% CI: 2.459-7.180; P<0.001) were independent predictors of OS. Patients with elevated ALBI or TyG values exhibited markedly shorter median survival compared with those with lower values. The ALBI-TyG nomogram showed robust discriminative ability, yielding an area under the ROC curve of 0.823 (95% CI: 0.768-0.878), outperforming either marker alone as well as traditional liver function scoring systems. Calibration plot demonstrated good agreement between predicted and observed survival probabilities, while DCA indicated superior net clinical benefit across a wide range of threshold probabilities. CONCLUSIONS: Combining ALBI score and TyG index offers an objective and accessible tool for prognostic assessment in HCC patients undergoing liver resection, enabling more personalized perioperative management.