Stefanini Bernardo, Fulgenzi Claudia Angela Maria, Scheiner Bernhard, Korolewicz James, Cheon Jaekyung, Nishida Naoshi, Ang Celina, Marron Thomas U, Wu Y Linda, Saeed Anwaar, Wietharn Brooke, Rimassa Lorenza, Pirozzi Angelo, Cammarota Antonella, Pressiani Tiziana, Pinter Matthias, Balcar Lorenz, Huang Yi-Hsiang, Mehan Aman, Phen Samuel, Vivaldi Caterina, Salani Francesca, Masi Gianluca, Bettinger Dominik, Vogel Arndt, Schönlein Martin, von Felden Johann, Schulze Kornelius, Wege Henning, Samson Adel, Galle Peter R, Kudo Masatoshi, Manfredi Giulia Francesca, Celsa Ciro, Awosika Nichola, Cortellini Alessio, Singal Amit G, Sharma Rohini, Chon Hong Jae, Tovoli Francesco, Piscaglia Fabio, Pinato David James, D'Alessio Antonio
Department of Surgery and Cancer, Imperial College London, London, UK.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
J Hepatocell Carcinoma. 2025 Apr 4;12:671-683. doi: 10.2147/JHC.S462701. eCollection 2025.
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.
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 χ2 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.
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).
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.
阿替利珠单抗和贝伐单抗（A+B）被推荐用于治疗不可切除的肝细胞癌（HCC）。尽管A+B非常有效，但可能导致包括出血在内的危及生命的不良事件。我们研究了白蛋白-胆红素（ALBI）分级是否比Child-Pugh（CP）评分能识别出出血风险更高的患者及其对预后的影响。
我们对15个三级转诊中心连续治疗的接受A+B治疗的患者进行了多中心回顾性研究。我们使用χ2检验分析ALBI分级与胃肠道出血之间的关联。采用Kaplan-Meier方法估计按ALBI分层的总生存期（OS），并通过ROC曲线分析6个月OS界标的预测价值。
在纳入分析的368例患者中，分别有163例（44.3%）、192例（52.2%）和13例（3.5%）的ALBI分级为1级、2级和3级。ALBI分级与出血风险增加3倍相关（ALBI 1级为3.1%，而ALBI 2/3级为10.2%，p=0.008）。在192例接受治疗前内镜检查的患者中，G2和G3级静脉曲张与出血风险增加相关，而G1级静脉曲张与无静脉曲张的出血风险相似。ALBI 1级患者的中位OS更长（未达到；95%CI，24.9-33.7），长于ALBI 2级（9.7个月；95%CI，7.0-12.3）或ALBI 3级（5.6个月；95%CI，0.1-12.0）。在预测6个月OS方面，ALBI的表现优于CP评分，ALBI的AUC为0.79，而CP评分为0.71（p=0.01）。
较高的ALBI分级与接受A+B治疗后胃肠道出血风险增加相关，并且在预测较差生存方面优于CP评分。
