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

Stefanini, B.; Fulgenzi, C.A.M.; Scheiner, B.; Korolewicz, J.; Cheon, J.; Nishida, N.; Ang, C.; Marron, T.U.; Wu, Y.L.; Saeed, A.; Wietharn, B.; Rimassa, L.; Pirozzi, A.; Cammarota, A.; Pressiani, T.; Pinter, M.; Balcar, L.; Huang, Y.-H.; Mehan, A.; Phen, S.; Vivaldi, C.; Salani, F.; Masi, G.; Bettinger, D.; Vogel, A.; Schonlein, M.; von Felden, J.; Schulze, K.; Wege, H.; Samson, A.; Galle, P.R.; Kudo, M.; Manfredi, G.F.; Celsa, C.; Awosika, N.; Cortellini, A.; Singal, A.G.; Sharma, R.; Chon, H.J.; Tovoli, F.; Piscaglia, F.; Pinato, D.J.; D'Alessio, A.

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

All Authors

Stefanini, B.

Fulgenzi, C.A.M.

Scheiner, B.

Korolewicz, J.

Cheon, J.

Nishida, N.

Ang, C.

Marron, T.U.

Wu, Y.L.

Saeed, A.

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LTHT Author

Samson, Adel

LTHT Department

Oncology
Leeds Cancer Centre

Publication Date

2025

Item Type

Article

Abstract

Background and Aims: Atezolizumab and bevacizumab (A+B) are recommended for treating unresectable hepatocellular carcinoma (HCC). Although highly effective, A+B can lead to potentially life-threatening adverse events including bleeding. We investigated whether albumin-bilirubin (ALBI) grade identifies patients with a higher risk of bleeding and its impact on prognosis than the Child-Pugh (CP) score. Method(s): We performed a multicenter retrospective study of 15 tertiary referral centers that consecutively treated patients with A+B. We analyzed the association between the ALBI grade and gastrointestinal bleeding using the chi2 test. Overall survival (OS) stratified by ALBI was estimated using the Kaplan-Meier method and the predictive value for the 6-months OS landmark with ROC curves. Result(s): Of the 368 patients included in the analysis, 163 (44.3%), 192 (52.2%) and 13 (3.5%) had ALBI 1, ALBI 2, and ALBI 3, respectively. ALBI grade was associated with a 3-fold increase in bleeding risk (3.1% in ALBI 1 vs 10.2% in ALBI 2/3, p=0.008). Among 192 patients with pre-treatment EGD, G2 and G3 varices were associated with an increased risk of bleeding, whereas G1 varices had a similar risk as no varices. Patients with ALBI 1 achieved a longer median OS (not reached; 95% CI, 24.9-33.7), than ALBI 2 (9.7 months; 95% CI, 7.0-12.3) or ALBI 3 (5.6 months; 95% CI, 0.1-12.0). ALBI outperformed the CP score for predicting 6-month OS with an AUC 0.79 of ALBI versus 0.71 for the CP score (p=0.01). Conclusion(s): A Higher ALBI grade was associated with an increased risk of gastrointestinal bleeding after receiving A+B, and outperformed the CP score in predicting worse survival.