Abstract 220P
Background
Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related mortality, with rising incidence in Pakistan. Viral hepatitis, predominantly HCV and HBV, accounts for 87% of HCC cases. Treatment for advanced HCC includes systemic therapies like sorafenib, lenvatinib, and atezolizumab/bevacizumab. This study evaluates the prognostic impact of the ALBI grade on overall and progression-free survival in patients at a tertiary hospital (Aga Khan University Hospital) in Karachi, Pakistan.
Methods
We conducted a retrospective analysis of patients with advanced HCC diagnosed and treated with first-line systemic therapy between 2017 and 2023 at the Aga Khan University Hospital. Median overall survival and time-to-progression analyses were performed using the Kaplan-Meier method. Adverse events were determined using CTCAE v5.0. The log-rank test assessed differences in survival across ALBI grades and types of systemic therapies used. Cox proportional hazards regression examined the impact of ALBI grading and other covariates on OS.
Results
We identified 104 patients with advanced HCC, treated with first-line systemic therapy including sorafenib (56), lenvatinib (31), and atezolizumab/bevacizumab (17). The cohort had a median OS of 9 months (95% CI 5-13) and a time to progression (TTP) of 3.25 months (IQR 0.5-31). The median OS was 21 months for ALBI Grade 1 patients (95% CI: 11 - 54) compared to 5 months for ALBI Grade 2-3 patients (95% CI: 4 - 9) (p<0.001). The median OS was highest for lenvatinib at 16 months (95% CI: 5-28), followed by sorafenib, at 9 months (95% CI: 4-13), and atezolizumab/bevacizumab, at 5.5 months (95% CI: 2-NR). Dose reductions were made in 84% of patients. The primary reason for dose reductions was deranged liver enzymes (48%). ALBI grade, Child-Pugh class, and extrahepatic metastasis were significant predictors of survival.
Conclusions
The ALBI grade, simpler and more objective than the Child-Pugh score, is a valuable prognostic tool for HCC patients. As assessed by ALBI, Lenvatinib shows a survival advantage over sorafenib and atezolizumab/bevacizumab, particularly in patients with better-preserved liver function.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Aga Khan University Hospital, Karachi, Pakistan.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.