Background and Aims: The albumin-bilirubin (ALBI) score is used for assessing the severity of liver dysfunction in patients with hepatocellular carcinoma and however, recent studies demonstrated that it may also have certain relevance with the prognosis of other malignant tumors. Therefore, this study was conducted to investigate the clinical value of using ALBI score or its combination with the commonly used pancreatic cancer marker carbohydrate antigen 19-9 (CA19-9) as the prognostic index for pancreatic cancer patients.  
Methods: The clinical data of 97 patients undergoing pancreatic cancer resection in the Department of General Surgery of Fuxin Mining General Hospital of Liaoning Health Industry Group from January 2010 to November 2014 were retrospectively analyzed. All these patients underwent determination of the serum levels of albumin, total bilirubin and CA19-9 on the day before operation. The correlation between serum albumin level and total bilirubin concentration in the patients, the relations of CA19-9 level with the clinicopathologic factors and ALBI score of the patients, as well as the associations of ALBI score and CA19-9 level with the prognosis of the patients were analyzed. 
Results: There was a significant correlation between serum albumin level and total bilirubin concentration in the pancreatic cancer patients (r=0.45, P=0.018). The ALBI score was significant related to whether or not the patients underwent preoperative biliary drainage due to biliary obstruction (P=0.008), but irrelevant to the CA19-9 level and all other clinicopathologic factors of the patients (all P>0.05). The 5-year survival rate in patients of high ALBI group was significantly lower than that in patients of low ALBI group (22.2% vs. 42.3%, P=0.036), and in patients of high CA19-9 group was significantly lower than that in patients of low CA19-9 group (24.1% vs. 44.2%, P=0.035); the results of combined analysis showed that the 5-year survival rates in patients with both high ALBI and high CA19-9 (double-high group), high ALBI and low CA19-9 (high ALBI group), low ALBI and high CA19-9 (high CA19-9 group) and both low ALBI and low CA19-9 (double-low group) were 12.0%, 35.0%, 34.5% and 52.2% respectively; the 5-year survival rate of double-high group was significantly lower than that of either single-high group (high ALBI group plus high CA19-9 group) or double-low group (12.0% vs. 34.7%, P=0.038; 12.0% vs. 52.2%, P=0.003), while no significant difference was noted between the latter two groups (P=0.159). The results of multivariate analysis showed that the combination of ALBI score and CA19-9 (P=0.009) along with the lymph node metastasis (P=0.012) were independent risk factors for the prognosis of pancreatic cancer patients. 
Conclusion: There is a certain relevance between the ALBI score and CA19-9 level in pancreatic cancer patients, and the combined parameter of ALBI score and CA19-9 level can be used as an independent prognostic factor for estimating the outcomes of pancreatic cancer patients. Those with concomitant high ALBI score and high CA19-9 level may face an unfavorable result.