Lu Chien-Hung, Kao Wei-Yu, Wu Chih-Horng, Ting Wei-Yi, Lu Chia-Hsun, Chuang Kai-I, Ni Cheng-Fu, Hsieh Yao-Yu, Wu Ming-Shun, Su Chien-Wei, Chen San-Chi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Liver Cancer. 2025 Apr 29:1-14. doi: 10.1159/000546185.
Lenvatinib effectively manages unresectable hepatocellular carcinoma (HCC). Current prognostic models do not integrate tumor burden with liver function. By combining the Up-to-7 criteria and the albumin-bilirubin (ALBI) grade, we developed the Up7-ALBI score, a novel scoring system for predicting survival outcomes in patients with unresectable HCC receiving lenvatinib.
This multicenter, retrospective study analyzed 205 patients with unresectable HCC. Tumor burden and liver function were assessed using the up-to-7 criteria and the ALBI grade, respectively. Cox proportional-hazards models evaluated their impact on survival. The Up7-ALBI score was developed to categorize patients into distinct prognostic groups. Its prognostic value was validated in a cohort of HCC patients receiving immunotherapy.
The overall response rate (assessed as per the Response Evaluation Criteria in Solid Tumors [RECIST] 1.1 criteria) was 13.2%. This rate was significantly higher for patients without metastases (18.6%) and those with a radiologic tumor burden within the up-to-7 criteria (22.7%). The median progression-free survival and overall survival (OS) were 7.3 and 12.2 months, respectively. Exceeding the up-to-7 criteria (hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.00-2.57) and an ALBI grade of 2 or 3 (HR: 1.62; 95% CI: 1.06-2.47) emerged as independent risk factors of OS. A novel Up7-ALBI score stratified patients into low-, intermediate-, and high-risk groups for survival (30.8 vs. 14.2 vs. 9.3 months; < 0.01). A validation cohort of 58 HCC patients with immunotherapy showed the consistent prognostic value of Up7-ALBI score. The Akaike information criterion value of the Cox proportional-hazards model for BCLC stage, ALBI grade, and Up7-ALBI score was 1,203, 1,174, and 1,170, respectively.
The Up7-ALBI score, incorporating tumor burden and liver function, effectively stratified survival outcomes in HCC patients treated with lenvatinib. Further validation in larger cohorts and across different systemic therapies is required to confirm its broad clinical applicability.
仑伐替尼可有效治疗不可切除的肝细胞癌（HCC）。目前的预后模型未将肿瘤负荷与肝功能相结合。通过结合Up-to-7标准和白蛋白-胆红素（ALBI）分级，我们开发了Up7-ALBI评分，这是一种用于预测接受仑伐替尼治疗的不可切除HCC患者生存结局的新型评分系统。
这项多中心回顾性研究分析了205例不可切除HCC患者。分别使用Up-to-7标准和ALBI分级评估肿瘤负荷和肝功能。Cox比例风险模型评估它们对生存的影响。开发Up7-ALBI评分以将患者分为不同的预后组。其预后价值在一组接受免疫治疗的HCC患者中得到验证。
总缓解率（根据实体瘤疗效评价标准[RECIST]1.1标准评估）为13.2%。无转移患者（18.6%）和放射学肿瘤负荷符合Up-to-7标准的患者（22.7%）的这一比率显著更高。中位无进展生存期和总生存期（OS）分别为7.3个月和12.2个月。超过Up-to-7标准（风险比[HR]：1.61；95%置信区间[CI]：1.00-2.57）和ALBI 2级或3级（HR：1.62；95%CI：1.06-2.47）是OS的独立危险因素。一种新型的Up7-ALBI评分将患者分为生存低、中、高风险组（30.8个月对14.2个月对9.
