ALBI Grade Enables Risk Stratification for Bleeding Events and Refines Prognostic Prediction in Advanced HCC...

Area of Science:

• Hepatobiliary Medicine
• Oncology
• Gastroenterology

Background:

• Atezolizumab and bevacizumab (A+B) combination therapy is a standard treatment for unresectable hepatocellular carcinoma (HCC).
• While effective, A+B therapy carries a risk of serious adverse events, notably bleeding.
• The Child-Pugh (CP) score is commonly used to assess liver function, but its ability to predict bleeding risk in HCC patients on A+B is limited.

Purpose of the Study:

• To evaluate the albumin-bilirubin (ALBI) grade's utility in identifying patients with unresectable HCC at increased risk of gastrointestinal bleeding during A+B therapy.
• To compare the predictive performance of the ALBI grade against the CP score for both bleeding events and overall survival (OS) in this patient cohort.

Main Methods:

• A multicenter retrospective study involving 368 patients with unresectable HCC treated with A+B.
• Analysis of the association between ALBI grade and gastrointestinal bleeding using the chi-squared test.
• Overall survival was estimated using Kaplan-Meier analysis, and predictive accuracy for 6-month OS was assessed using ROC curves, comparing ALBI and CP scores.

Main Results:

• Patients with higher ALBI grades (2/3) exhibited a significantly higher risk of bleeding compared to those with ALBI grade 1 (10.2% vs 3.1%).
• Pre-treatment esophageal varices (G2/G3) were associated with increased bleeding risk, while G1 varices showed similar risk to no varices.
• The ALBI grade demonstrated superior predictive performance for 6-month OS (AUC 0.79) compared to the CP score (AUC 0.71).
• Patients with ALBI grade 1 had significantly longer median overall survival than those with ALBI grades 2 or 3.

Conclusions:

• The ALBI grade is a valuable tool for identifying patients with unresectable HCC who are at higher risk of gastrointestinal bleeding when treated with atezolizumab and bevacizumab.
• The ALBI grade outperforms the CP score in predicting survival outcomes in this patient population.
• Integrating ALBI grade assessment may aid in optimizing treatment strategies and patient monitoring for A+B therapy in HCC.