Publication

Abstract : Background The baseline liver function of patients initiating treatment for advanced hepatocellular carcinoma influences survival and may affect treatment efficacy and safety outcomes. The albumin-bilirubin (ALBI) score is a recently developed index of liver function used to evaluate the prognosis of patients with hepatocellular carcinoma (HCC). This study investigates the impact of baseline ALBI grade and Child Pugh score on hepatocellular carcinoma patients who received lenvatinib. Methods We included all patients who received lenvatinib as first-line/second-line treatment for advanced HCC at our institution from 2019 to 2024. Data were collected ambispectively from electronic medical records. This study evaluated the relationships between baseline liver function, measured by the Child–Pugh score and ALBI grade, and treatment outcomes in hepatocellular carcinoma patients receiving lenvatinib. Outcomes assessed included the objective response rate based on mRECIST (modified Response Evaluation Criteria in Solid Tumors), time to treatment failure, treatment duration, and the likelihood of treatment discontinuation due to adverse events. Patients were categorized into four groups: (1) Child–Pugh score A5 with ALBI grade 1 (group 1), (2) Child–Pugh score A5 with ALBI grade 2 (group 2), (3) Child–Pugh score A6 (group 3), and (4) Child–Pugh score ≥7 (group 4). Univariate analyses were conducted to identify factors influencing the objective response rate and the risk of treatment discontinuation due to adverse events. Results A total of 480 HCC patients treated with lenvatinib were included. Results showed that the majority of ALBI grade 1 was Child Pugh A (93.5%); ALBI grade 2 was seen in Child Pugh score of 5, 6, 7, ≥8, whereas ALBI grade 3 was reported in Child Pugh score ≥7 (89.47%). Among the 480 patients analyzed, group 2 had the most favorable response pattern with the highest proportion of stable disease and lowest progression rate. Conclusions Patients with Child Pugh score A5 and ALBI grade 2 predicted a higher response rate and lower treatment discontinuation due to adverse events by Lenvatinib treatment.