Bernardo Stefanini, Claudia Angela Maria Fulgenzi, Bernhard Scheiner, James Korolewicz, Jaekyung Cheon, Naoshi Nishida, Celina Ang, Thomas U Marron, Y Linda Wu, Anwaar Saeed, Brooke Wietharn, Lorenza Rimassa, Angelo Pirozzi, Antonella Cammarota, Tiziana Pressiani, Matthias Pinter, Lorenz Balcar, Yi-Hsiang Huang, Aman Mehan, Samuel Phen, Caterina Vivaldi, Francesca Salani, Gianluca Masi, Dominik Bettinger, Arndt Vogel, Martin Schönlein, Johann von Felden, Kornelius Schulze, Henning Wege, Adel Samson, Peter R Galle, Masatoshi Kudo, Giulia Francesca Manfredi, Ciro Celsa, Nichola Awosika, Alessio Cortellini, Amit G Singal, Rohini Sharma, Hong Jae Chon, Francesco Tovoli, Fabio Piscaglia, David James Pinato, Antonio D'Alessio
{"title":"ALBI分级使出血事件的风险分层和阿特唑单抗和贝伐单抗后晚期HCC的预后预测更加精确。","authors":"Bernardo Stefanini, Claudia Angela Maria Fulgenzi, Bernhard Scheiner, James Korolewicz, Jaekyung Cheon, Naoshi Nishida, Celina Ang, Thomas U Marron, Y Linda Wu, Anwaar Saeed, Brooke Wietharn, Lorenza Rimassa, Angelo Pirozzi, Antonella Cammarota, Tiziana Pressiani, Matthias Pinter, Lorenz Balcar, Yi-Hsiang Huang, Aman Mehan, Samuel Phen, Caterina Vivaldi, Francesca Salani, Gianluca Masi, Dominik Bettinger, Arndt Vogel, Martin Schönlein, Johann von Felden, Kornelius Schulze, Henning Wege, Adel Samson, Peter R Galle, Masatoshi Kudo, Giulia Francesca Manfredi, Ciro Celsa, Nichola Awosika, Alessio Cortellini, Amit G Singal, Rohini Sharma, Hong Jae Chon, Francesco Tovoli, Fabio Piscaglia, David James Pinato, Antonio D'Alessio","doi":"10.2147/JHC.S462701","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15906,"journal":{"name":"Journal of Hepatocellular Carcinoma","volume":"12 ","pages":"671-683"},"PeriodicalIF":3.4000,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977629/pdf/","citationCount":"0","resultStr":"{\"title\":\"ALBI Grade Enables Risk Stratification for Bleeding Events and Refines Prognostic Prediction in Advanced HCC Following Atezolizumab and Bevacizumab.\",\"authors\":\"Bernardo Stefanini, Claudia Angela Maria Fulgenzi, Bernhard Scheiner, James Korolewicz, Jaekyung Cheon, Naoshi Nishida, Celina Ang, Thomas U Marron, Y Linda Wu, Anwaar Saeed, Brooke Wietharn, Lorenza Rimassa, Angelo Pirozzi, Antonella Cammarota, Tiziana Pressiani, Matthias Pinter, Lorenz Balcar, Yi-Hsiang Huang, Aman Mehan, Samuel Phen, Caterina Vivaldi, Francesca Salani, Gianluca Masi, Dominik Bettinger, Arndt Vogel, Martin Schönlein, Johann von Felden, Kornelius Schulze, Henning Wege, Adel Samson, Peter R Galle, Masatoshi Kudo, Giulia Francesca Manfredi, Ciro Celsa, Nichola Awosika, Alessio Cortellini, Amit G Singal, Rohini Sharma, Hong Jae Chon, Francesco Tovoli, Fabio Piscaglia, David James Pinato, Antonio D'Alessio\",\"doi\":\"10.2147/JHC.S462701\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":15906,\"journal\":{\"name\":\"Journal of Hepatocellular Carcinoma\",\"volume\":\"12 \",\"pages\":\"671-683\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-04-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977629/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hepatocellular Carcinoma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/JHC.S462701\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hepatocellular Carcinoma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/JHC.S462701","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
ALBI Grade Enables Risk Stratification for Bleeding Events and Refines Prognostic Prediction in Advanced HCC Following Atezolizumab and Bevacizumab.
Background and aims: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
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