Modified albumin-bilirubin grade predicts overall and progression-free survival in metastatic gastric cancer

Gastric cancer (GC) ranks among the most prevalent and lethal cancers worldwide. The albumin-bilirubin (ALBI) score was initially developed to assess liver function in patients with hepatocellular carcinoma. Its modified version, the modified ALBI (mALBI) score, may offer prognostic insights for other malignancies. This study aims to evaluate the prognostic significance of mALBI grade in patients with metastatic GC. Between August 2021 and June 2025, a total of 93 patients with metastatic GC were included in this retrospective multicenter cohort study. mALBI scores were calculated based on serum albumin and total bilirubin concentrations. Patients were classified according to the original mALBI grading system into Grade 1, Grade 2a, Grade 2b, and Grade 3. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method, while independent prognostic factors were analyzed via Cox regression. Kaplan-Meier analysis indicated significant differences in OS (χ² = 44.156, p < 0.001) and PFS (χ² = 22.142, p < 0.001) across the four mALBI grades. Utilizing established mALBI grade thresholds and prior binary grouping methods in GC, patients were further divided into low mALBI (Grades 1 and 2a) and high mALBI (Grades 2b and 3) groups. Those with high mALBI grades exhibited significantly worse median OS compared to patients with low mALBI grades (271 vs. 561 days, p = 0.002), as well as significantly shorter median PFS (199 vs. 423 days, p < 0.001). In multivariate analysis, mALBI grade remained independently associated with both OS (p < 0.001) and PFS (p = 0.001). Patients with lower mALBI grades demonstrated considerably better survival outcomes than those with higher grades. Due to its straightforward calculation from routine laboratory tests, mALBI grade may serve as a valuable prognostic marker for survival stratification in metastatic GC. Nonetheless, prospective validation in larger and more diverse cohorts is necessary before its integration into standard clinical practice. Furthermore, additional studies should explore whether interventions aimed at enhancing nutritional status and liver function can positively impact outcomes in high-risk patients.