Prognostic Value of albumin-bilirubin (ALBI) Grade in Patients with Gastric Cancer: A Systematic Review and meta-analysis.

[BACKGROUND] Gastric cancer (GC) is considered a leading cause of cancer-related deaths. Identifying patients with poor survival outcomes and factors related to prognosis are crucial measures in patient care. In addition to the existing prognostic markers, new markers need to be introduced to overcome their limitations and improve risk stratification. In this systematic review and meta-analysis, we aim to assess the albumin-bilirubin (ALBI) grade as a novel prognostic marker in patients with GC.

[METHOD] The PubMed, Web of Science, Embase, and Scopus databases were searched from inception to April 4, 2025. Studies investigating the prognostic value of the ALBI grade in GC were included. The prognostic efficacy was evaluated using hazard ratio (HR) with 95% confidence interval (95% CI). The meta-analysis was performed using R version 4.5.1.

[RESULT] The meta-analysis included 3,459 patients in the univariate analysis for overall survival (OS) and 2,503 in the multivariate analysis. A higher ALBI grade was associated with worse OS in both univariate (HR = 3.05; 95%CI, 1.74-5.33; P ˂ 0.0001) and multivariate analyses (HR = 1.89; 95%CI, 1.30-2.76; P = 0.0010). A meta-analysis of 888 patients also showed that a higher ALBI grade was associated with worse recurrence-free survival/disease-free survival (RFS/DFS) in both univariate (HR = 2.23; 95%CI, 1.74-2.85; P ˂ 0.0001) and multivariate analyses (HR = 1.86; 95%CI, 1.42-2.43; P ˂ 0.0001).

[CONCLUSION] A higher ALBI grade is associated with worse OS and RFS/DFS. This novel marker could be used to complement the existing prognostic markers and enhance survival prediction in patients with GC.