Validation of the Up7-ALBI Score for Prognostication in Unresectable Hepatocellular Carcinoma Treated with Atezolizumab Plus Bevacizumab.

Abstract

Purpose: A well-established prognostic scoring system for unresectable hepatocellular carcinoma (uHCC) receiving systemic therapy is lacking. The Up7-ALBI score has shown prognostic value for lenvatinib. This study aimed to validate its prognostic value in uHCC treated with atezolizumab plus bevacizumab (atezo-bev).

Patients and methods: This retrospective multicenter study included 225 patients with uHCC who received first-line atezo-bev in Taiwan between 2017 and 2025. The Up7-ALBI score (0-2), combining tumor burden (within vs beyond up-to-7) and ALBI grade (1 vs 2-3), categorized patients into low-, intermediate-, and high-risk groups. The score was used to stratify progression-free survival (PFS) and overall survival (OS), with multivariate Cox analysis performed. Prognostic performance was compared with previously reported scoring systems.

Results: The objective response rate (ORR) and disease control rate were 44.4% and 60.4%, respectively, and the median PFS and OS were 7.0 and 23.8 months. Among the 225 enrolled patients, 178 patients had complete data for Up7-ALBI analysis. The Up7-ALBI score significantly stratified outcomes, with median OS not reached, 36.0 months, and 9.2 months for scores 0, 1, and 2 (p < 0.01); median PFS of 13.4, 7.9, and 5.8 months (p < 0.01); and ORR of 66.7%, 52.2%, and 32.9%, respectively (p < 0.01). Multivariate analysis showed that Up7-ALBI scores 1 and 2, along with macrovascular invasion, were independent risk factors for OS. The Up7-ALBI score demonstrated the lowest Akaike information criterion (484.3) among the previously proposed scores.

Conclusion: This study validated the Up7-ALBI score for uHCC receiving atezo-bev. Its consistent prognostic performance across systemic therapies supports its potential as a simple, clinically applicable risk-stratification tool.