Optimizing TACE Method Selection for Patients with Postoperative Recurrence of Hepatocellular Carcinoma Based on ALBI Score

Objectives To evaluate transarterial chemoembolization (TACE) selection for postoperative hepatocellular carcinoma (HCC) patients based on albumin-bilirubin (ALBI) grade. Methods This retrospective study analyzed 239 HCC patients with postoperative recurrence treated with drug-eluting bead TACE (DEB-TACE) or conventional TACE (cTACE) from January 2016 to December 2024. Cox regression identified survival predictors, and patients were stratified for survival analysis. Results This study included a total of 239 patients with a median follow-up time of 27 months, including 118 cases of DEB-TACE and 121 cases of cTACE. Multivariate analysis suggested that AFP ( p  = 0.002), albumin ( p  = 0.003), and ALBI grade ( p  < 0.001) were independent prognostic factors for OS. We discovered that, regardless of whether DEB-TACE or cTACE was employed, the OS of patients with ALBI grade II-III was shorter ( p  < 0.05). Among patients with ALBI grade II-III, those treated with DEB-TACE demonstrated longer overall survival ( p  < 0.05). However, no significant difference in survival was observed between DEB-TACE and cTACE patients at ALBI grade I ( p  > 0.05). Conclusion ALBI grade is a key prognostic factor for recurrent HCC. DEB-TACE may improve survival in ALBI II–III patients, whereas either method is suitable for ALBI grade I.