BACKGROUND : Gallbladder cancer (GBC) has been associated with high rates of recurrence and dismal prognosis even after curative-intent resection. The prognostic utility of the modified ALBI (mALBI) score among individuals undergoing curative-intent resection for GBC has not been determined.

METHODS : Patients undergoing radical resection for GBC between 2000-2022 were identified from an international, multi-institutional database. Preoperative albumin and bilirubin levels were used to calculate the mALBI score. The relationship between mALBI, overall survival (OS), and recurrence-free survival (RFS) was examined.

RESULTS : Among 269 patients undergoing radical resection for GBC, 59.9% of patients had mALBI grade 1, 17.8% had grade 2a, 17.5% had grade 2b, and 4.8% had mALBI grade 3. Following surgery, patients with high mALBI (Grade 2b/3) had worse 5-year OS (19.2% vs. 54.4%, p<0.001) and RFS (17.8% vs. 42.0%, p<0.001) compared with patients with a low mALBI (Grade 1/2a) score. On multivariable analysis, after controlling for relevant clinicopathologic variables, a high mALBI score remained independently associated with higher hazards of death and recurrence (OS: HR 2.38, 95%CI 1.50-3.79; RFS: HR 2.12, 95%CI 1.41-3.20) compared with individuals with a low mALBI score following curative-intent resection for GBC. Of note, mALBI was associated with incrementally worse survival within T2, T3, and N+ categories, whereas classic AJCC subclassifications failed to distinguish patients relative to long-term survival.

CONCLUSION : The mALBI score presents a simple, objective measure of hepatic functional reserve and may be a useful prognostic tool as applied to patients undergoing curative-intent resection for GBC.