ALBI Grade, MVI, & Distant Metastases Predict Survival in HCC

Albumin-bilirubin (ALBI) grade, microvascular invasion (MVI), and distant metastases predict length of survival in hepatocellular carcinoma (HCC), researchers reported at the 2024 ASCO Annual Meeting.

“This study supports higher ALBI grade, MVI, and distant metastases as predictors of short-term death (STD), while lower ALBI grade, absence of MVI and lack of distant metastases were predictive of long-term survival (LTS) in patients with HCC treated with contemporary tyrosine kinase inhibitors (TKIs) or immunotherapy combination regimens,” Pooya Dibajnia, MD, FRCPC, CCFP, and colleagues wrote in the abstract of their poster presentation. “These predictors may help guide treatment decisions in patient populations underrepresented in clinical trials, including patients with Child-Pugh B7 score who are often excluded.”

Advances in systemic therapy, including tyrosine kinase inhibitors and immunotherapy combinations, have increased hepatocellular carcinoma treatment options, and variables that predict patient outcomes may help personalize treatment decisions.

To identify predictors of STD and LTS in patients with HCC, the researchers reviewed patients with advanced hepatocellular carcinoma who received a tyrosine kinase inhibitor or immunotherapy combinations between August 2018 and August 2020. The study was carried out in the Canadian provinces of Alberta, British Columbia, Manitoba, and Nova Scotia and in two institutions in Ontario, and prior locoregional therapies were allowed.

At baseline, the 520 patients included in the study had a median 66 years of age, 84.6% male, 87.4% had Eastern Cooperative Oncology Group (ECOG) performance status 0-1, 69.7% were BCLC stage C, and 88.7% were Child-Pugh A. First-line treatments primarily consisted of lenvatinib 57.3%, sorafenib 8.1%, and atezolizumab/bevacizumab 31.7%.

The authors analyzed data on Barcelona Clinic Liver Cancer (BCLC) stage, Child-Pugh class, ALBI grade, alpha fetoprotein (AFP) level, MVI, and distant metastases. They used multivariate logistic regression to determine independent predictors of STD (patient survival shorter than 6 months vs others) and LTS (patient survival longer than 18 months vs others).

The authors found that:

• Median progression-free survival was 7.4 months (95% CI, 6.2-8.4), and overall survival was 17.1 months (95% CI, 15.1-18.8).
• Independent predictors of STD were (odds ratio): ALBI grade (2.26), MVI (2.13), and distant metastases (2.14).
• ALBI grade (0.45), MVI (0.49), and distant metastases (0.36) were also predictive for LTS, although Child-Pugh class, AFP, and BCLC stage were not predictive of either STD or LTS.