Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 15;15(10):1771-1783.
doi: 10.4251/wjgo.v15.i10.1771.

Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

Affiliations

Modified albumin-bilirubin predicted survival of unresectable hepatocellular carcinoma patients treated with immunotherapy

Huttakan Navadurong et al. World J Gastrointest Oncol. .

Abstract

Background: Modified albumin-bilirubin (mALBI) grade has been established as a survival determinant in hepatocellular carcinoma (HCC) patients who receive locoregional and targeted therapies.

Aim: To investigate whether mALBI could predict survival in unresectable HCC (uHCC) patients who were treated with atezolizumab plus bevacizumab (AB).

Methods: A single-center, retrospective cohort study enrolled uHCC patients who received AB treatment between September 2020 and April 2023 and were followed up until June 2023. An association between mALBI and patient survival was determined using Cox proportional hazards analysis.

Results: Of the 83 patients, 67 patients (80.7%) were male with the mean age of 60.6 years. Among them, 22 patients (26.5%) were classified as Barcelona Clinic Liver Cancer B, and 61 patients (73.5%) were classified as Barcelona Clinic Liver Cancer C. Cirrhosis was present in 76 patients (91.6%), with 58 patients classified as Child-Turcotte-Pugh (CTP) A and 18 as CTP B. The median overall survival (OS) and progression-free survival were 13.0 mo [95% confidence interval (CI): 5.2-20.8] and 9.0 mo (95%CI: 5.0-13.0), respectively. The patients were divided into two groups based on mALBI grades: 42 patients (50.6%) in the mALBI 1 + 2a group; and 41 patients (49.4%) in the mALBI 2b + 3 group. During the median follow-up period of 7.0 mo, the mALBI 1 + 2a group exhibited significantly better survival compared to the mALBI 2b + 3 group, with a median OS that was not reached vs 3.0 mo (95%CI: 0.1-6.0, P < 0.001). In a subgroup of patients with CTP A, the mALBI 1 + 2a group also showed significantly longer survival compared to the mALBI 2b + 3 group, with a median OS that was not reached vs 6.0 mo (95%CI: 3.4-8.6, P < 0.001). In the multivariate analysis, both CTP class and mALBI grade were independently associated with survival, with adjusted hazard ratios (95%CI) of 2.63 (1.19-5.78, P = 0.020) and 3.90 (1.71-8.90, P = 0.001), respectively.

Conclusion: mALBI grades can determine survival of uHCC patients receiving AB treatment, particularly those who have mildly impaired liver function. This highlights the importance of assessing mALBI before initiating AB treatment to optimize therapeutic efficacy in clinical practice.

Keywords: Atezolizumab plus bevacizumab; Immunotherapy; Liver function; Modified albumin-bilirubin grade; Unresectable hepatocellular carcinoma.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of patient enrollment. BCLC: Barcelona Clinic Liver Cancer; CCA: Cholangiocarcinoma; HCC: Hepatocellular carcinoma; mALBI: Modified albumin-bilirubin.
Figure 2
Figure 2
Kaplan–Meier analysis of overall survival and progression free survival of the unresectable hepatocellular carcinoma patients who received atezolizumab plus bevacizumab therapy. A: Overall survival (OS) in unresectable hepatocellular carcinoma (uHCC) patients who received atezolizumab plus bevacizumab (AB); B: Progression-free survival (PFS) in uHCC patients who received AB. CI: Confidence interval.
Figure 3
Figure 3
Kaplan-Meier curves for overall survival in patients undergoing atezolizumab plus bevacizumab therapy stratified by modified albumin-bilirubin grade. A: Entire cohort; B: Child-Turcotte-Pugh (CTP) class A. CI: Confidence interval; gr: Group; mALBI: Modified albumin-bilirubin; NA: Not available; OS: Overall survival.
Figure 4
Figure 4
Kaplan-Meier curves for overall survival in patients undergoing atezolizumab plus bevacizumab therapy stratified by modified albumin-bilirubin grade in Barcelona Clinic Liver Cancer B and C. 1P = 0.014; 2P < 0.001. BCLC: Barcelona Clinic Liver Cancer; gr: Group; mALBI: Modified albumin-bilirubin.

Similar articles

Cited by

References

    1. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391:1301–1314. - PubMed
    1. Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, Kelley RK, Galle PR, Mazzaferro V, Salem R, Sangro B, Singal AG, Vogel A, Fuster J, Ayuso C, Bruix J. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76:681–693. - PMC - PubMed
    1. Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1–85. - PubMed
    1. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O'Beirne J, Fox R, Skowronska A, Palmer D, Yeo W, Mo F, Lai P, Iñarrairaegui M, Chan SL, Sangro B, Miksad R, Tada T, Kumada T, Toyoda H. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol. 2015;33:550–558. - PMC - PubMed
    1. Toyoda H, Johnson PJ. The ALBI score: From liver function in patients with HCC to a general measure of liver function. JHEP Rep. 2022;4:100557. - PMC - PubMed