HCC Without Cirrhosis - Child-Pugh and ALBI Scores Still Predict Survival: JHEP Reports | October 2026

What Did the Study Find?

This international study evaluated whether Child-Turcotte-Pugh (CTP) classification and albumin-bilirubin (ALBI) grade retain prognostic value in patients with hepatocellular carcinoma (HCC) without underlying cirrhosis.

• The analysis included 2,457 patients with unresectable HCC, comprising 443 without cirrhosis and 2,014 with cirrhosis.
• Two independent cohorts were evaluated: a European HCC cohort and an international cohort receiving atezolizumab/bevacizumab or durvalumab/tremelimumab.
• In noncirrhotic HCC, CTP classification independently predicted overall survival, even after adjustment for BCLC stage and other prognostic factors.
• Worse CTP classification was associated with approximately threefold higher mortality risk in both cohorts (adjusted HR 3.04 and 3.24).
• ALBI grade also independently predicted survival, with prognostic performance comparable to CTP classification.
• Importantly, the predictive performance of both scores was comparable between cirrhotic and noncirrhotic HCC populations.
• These findings suggest that liver functional reserve remains prognostically relevant even when established cirrhosis is absent.

Why Does It Matter?

HCC prognosis is traditionally determined by tumour burden, liver function and performance status. However, clinicians may underestimate the importance of liver functional assessment when HCC develops without cirrhosis, particularly in patients with MASLD/MASH or chronic hepatitis B.

This study demonstrates that the absence of cirrhosis does not eliminate the prognostic importance of hepatic functional impairment.

GastroAGI Takeaway

In HCC, assess liver function even when the patient does not have cirrhosis.

Both Child-Pugh classification and ALBI grade provide meaningful survival stratification in noncirrhotic HCC, supporting their incorporation alongside BCLC staging and performance status.

ALBI is particularly attractive because it uses only albumin and bilirubin, providing a simple, objective and reproducible assessment.