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

Huttakan Navadurong; Thaninee Prasoppokakorn; Nanicha Siriwong; Chonlada Phathong; Nattaya Teeyapun; Suebpong Tanasanvimon; Kessarin Thanapirom; Piyawat Komolmit; Pisit Tangkijvanich; Sombat Treeprasertsuk; Roongruedee Chaiteerakij

doi:10.4251/wjgo.v15.i10.1771

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

World J Gastrointest Oncol. 2023 Oct 15;15(10):1771-1783. doi: 10.4251/wjgo.v15.i10.1771.

Authors

Huttakan Navadurong^{1

2}, Thaninee Prasoppokakorn^{1

2}, Nanicha Siriwong^{1

2}, Chonlada Phathong^{1

2}, Nattaya Teeyapun^{2

3}, Suebpong Tanasanvimon^{2

3}, Kessarin Thanapirom^{1

2}, Piyawat Komolmit^{1

2}, Pisit Tangkijvanich⁴, Sombat Treeprasertsuk^{1

2}, Roongruedee Chaiteerakij^{1

2

5}

Affiliations

¹ Department of Medicine, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
² The Thai Red Cross Society, Bangkok 10330, Thailand.
³ Department of Medicine, Division of Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
⁴ Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
⁵ Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. roon.chaiteerakij@chula.md.

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.