Hiraoka A, Kato M, Marui K, et al. - Given low branched-chain amino acid (BCAA) to tyrosine ratio (BTR) represents an indicator of amino acid imbalance, researchers herein assessed the utility of newly created albumin–bilirubin (ALBI) score as alternative tools of BTR in patients with naïve hepatocellular carcinoma (HCC) retrospectively. Links among BTR and clinical characteristics were examined in 842 patients with HCC and without BCAA supplementation (71 years, male 614, Child-Pugh A:B:C = 689:116:37). A total of 438 of those patients, with Milan criteria HCC, managed curatively were split into the high-BTR (>4.4) (n = 293) and low-BTR (≤4.4) (n = 145) groups. A worse prognosis was observed in the low-BTR group vs the other. Significant prognostic factors revealed in multivariate Cox-hazard analysis adjusted for inverse probability weighting were: elderly, female gender, Eastern Cooperative Oncology Group performance status ≥ 2, low platelet count, and low BTR (≤4.4). Findings revealed ALBI score −2.588 predicted low-BTR (≤4.4), which was recognized as prognostic factors for early HCC cases, and the presence of an amino acid imbalance might be seen in at least patients with modified ALBI grade 2b.