The Treatment Strategies for Intermediate-Advanced Hepatocellular Carcinoma Based on Albumin-Bilirubin Grade: A Multicenter Retrospective Cohort Study.

Authors

Kang Liang, Jianwei Liu, Xiaorong Pan, Yuxuan Lin, Kongying Lin, Hui Xue, Jing Li, Huichuan Sun, Kui Wang, China Liver Cancer Study Group Young Investigators (CLEAP)

Published in

Cancer medicine. Volume 15. Issue 11.

Abstract

To evaluate whether the albumin-bilirubin (ALBI) grade modifies the association of combined locoregional plus systemic therapy versus systemic therapy alone with outcomes in unresectable hepatocellular carcinoma (HCC).
This multicente retrospective study enrolled 525 patients, stratified by the established ALBI grade cut-off into ALBI-low (Grade 1, ALBI score ≤ -2.60, n = 257) and ALBI-high (Grade 2/3, n = 268). Propensity score matching (PSM) was performed in the whole cohort and within each ALBI stratum; survival, tumor response, and safety were compared in matched cohorts, with effect modification tested by a treatment × ALBI interaction term.
After PSM, combination therapy was associated with better overall survival (OS) (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.34-0.76; p = 0.001) and progression-free survival (PFS) (HR 0.73, 95% CI 0.56-0.96; p = 0.024). The association was observed in ALBI-low patients (OS: HR 0.32, 95% CI 0.18-0.56, p < 0.001; PFS: HR 0.59, 95% CI 0.41-0.85, p = 0.004), who also had higher objective response rates by modified Response Evaluation Criteria in Solid Tumors (mRECIST; 70.9% vs. 38.8%, p < 0.001) and RECIST 1.1 (55.3% vs. 30.1%, p < 0.001). No significant association was seen in ALBI-high patients (OS: HR 0.83, 95% CI 0.47-1.45, p = 0.504; PFS: HR 1.06, 95% CI 0.71-1.58, p = 0.792), and the treatment × ALBI interaction was significant for OS (p = 0.019) and PFS (p = 0.035). Overall and Grade 3-4 adverse reactions were comparable, but elevated bilirubin (33.0% vs. 17.0%, p = 0.012) and transaminases (35.1% vs. 20.2%, p = 0.022) were more frequent with combination therapy in the ALBI-high cohort.
In this multicenter real-world cohort, combination therapy was associated with better outcomes in patients of ALBI Grade 1 but not Grade 2/3, in whom hepatic toxicity was more frequent, and the exploratory treatment × ALBI interaction was significant. ALBI grade may help identify patients more likely to benefit from combined locoregional and systemic therapy, although prospective validation is required.

PMID:
42989691
Bibliographic data and abstract were imported from PubMed on 06 Nov 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.