ArticleThe oncologist2026
The albumin-bilirubin score predicts outcomes in advanced biliary tract cancer treated with durvalumab immunochemotherapy.
Article in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe albumin-bilirubin (ALBI) score objectively reflects hepatic functional reserve and is widely used as a prognostic biomarker in hepatocellular carcinoma. However, its prognostic value in patients with biliary tract carcinoma (BTC) treated with durvalumab plus gemcitabine-cisplatin (GCD) remains unclear. MATERIAL AND
methodsWe retrospectively analyzed 172 patients with unresectable or metastatic BTC who received first-line GCD between 2021 and 2025. Baseline ALBI scores were calculated and patients were stratified into cohort-specific tertiles (Q1-Q3). Overall survival (OS) was estimated using Kaplan-Meier method and Cox regression hazards models. Predictive performance for OS was compared between ALBI and the Eastern Cooperative Oncology Group performance status (ECOG PS) using time-dependent area under the receiver operating characteristic curves (AUC) analysis.
resultsThe median OS was 13.8 months (95% CI, 9.9-17.7). Survival differed significantly across ALBI tertiles: median OS was 24.0 months (95% CI, 10.3-37.8) for Q1, 14.4 months (95% CI, 9.2-19.6) for Q2, and 5.9 months (95% CI, 2.5-9.2) for Q3 (P < .001). In multivariate analysis, ALBI remained an independent prognostic factor for OS (Q3 vs Q1, adjusted hazard ratio 2.16; 95% CI, 1.16-4.04; P = .016). The ALBI score demonstrated improved prognostic discrimination (AUC 0.714 at 6 months; 0.656 at 12 months) compared with ECOG PS (AUC 0.591 and 0.551, respectively). Tumor response rates were similar across tertiles, but higher ALBI scores were associated with an increased incidence of grade ≥3 toxicities.
conclusionThe pretreatment ALBI score is a simple, objective, and independent prognostic biomarker for patients with advanced BTC receiving durvalumab-based immunochemotherapy. Incorporating ALBI into baseline assessment may help identify high-risk patients who warrant closer monitoring or individualized therapeutic strategies.
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