Albumin-bilirubin grade and sarcopenia as predictors of prognosis in patients with unresectable intermediate and advanced-stage hepatocellular carcinoma.

Authors

Biswajit Sahoo, Jagabandhu Hembram, Manas Kumar Panigrahi, Sourav Kumar Mishra, Sandip Kumar Barik, Saroj Kumar Das Majumdar, Hemanta Kumar Nayak, Manoj Kumar Nayak, Phanindra Kumar Swain, Arunprakash Pitchaimuthu, Suprava Naik, Dillip Kumar Muduly, Kiran Ygl, Shilpy Jha, Priyadip Maiti, Subhabrata Biswal

Published in

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology. Jul 06, 2026. Epub Jul 06, 2026.

Abstract

To evaluate the efficacy of the albumin-bilirubin (ALBI) grade, easy albumin-bilirubin (EZ-ALBI) grade and sarcopenia in predicting the prognosis of patients with unresectable hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) as monotherapy or in combination with Lenvatinib.
Thirty-eight patients with Barcelona Clinic Liver Cancer (BCLC) stage B and 36 patients with stage C HCC received TACE and TACE with Lenvatinib, respectively. Tumor response was assessed according to the modified RECIST (mRECIST) criteria. ALBI, EZ-ALBI grades and sarcopenia were measured both prior to TACE and during follow-up. Prognostic outcomes were determined based on objective response rate (ORR), progression rate and progression-free survival (PFS). Appropriate statistical analyses were used; p < 0.05 was considered significant.
In stage B, ORR, tumor progression and PFS showed significant variation with ALBI grades (p = 0.004, p = 0.001, p < 0.001), but not with sarcopenia (p = 0.090, p = 0.310, p = 0.114). ORR exhibited no significant difference across EZ-ALBI grades (p = 0.055), whereas tumor progression and PFS demonstrated significant differences (p = 0.025, p = 0.004). In stage C, ORR, tumor progression and PFS varied significantly according to ALBI grades (p = 0.011, p = 0.002, p < 0.001) and were worse in patients with sarcopenia (p = 0.006, p = 0.039, p = 0.012). Although ORR did not differ significantly across EZ-ALBI grades (p = 0.158), tumor progression and PFS showed significant differences (p = 0.033 and p < 0.001).
ALBI and EZ-ALBI grades demonstrated significant prognostic value for patients with intermediate-stage HCC undergoing TACE, as well as for those with advanced-stage HCC receiving TACE in combination with Lenvatinib. The presence of sarcopenia correlated with a poorer prognosis and diminished response in patients with advanced HCC treated with TACE and Lenvatinib; however, no definitive association was identified in patients classified as BCLC stage B following TACE.

PMID:
42410238
Bibliographic data and abstract were imported from PubMed on 07 Jul 2026.

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