ALBI-6-A Novel Prognostic Score Combining ALBI and Interleukin-6 in Patients With HCC Treated With Atezolizumab and Bevacizumab.

BACKGROUND/AIMS: Despite widespread use of combination immunotherapy in advanced liver cancer, reliable biomarkers for baseline risk stratification remain lacking. The inflammatory cytokine interleukin-6 has established prognostic relevance in this cancer. We investigated the prognostic value of interleukin-6 and developed a combined score (ALBI-6) integrating interleukin-6 with albumin-bilirubin grade, a marker of liver function.

METHODS

In this multicentre retrospective cohort study, 216 patients with advanced hepatocellular carcinoma treated with first-line atezolizumab plus bevacizumab were analysed. Interleukin-6 was measured at baseline, first response, best response, and progression. The cohort was randomly divided into a training set (n = 98) and a validation set (n = 90). ALBI-6 was derived using Cox regression and evaluated against several established prognostic scores.

RESULTS

Elevated baseline interleukin-6 was consistently associated with worse overall survival and remained independently prognostic after adjustment for tumour and clinical factors (extrahepatic spread, vascular invasion, alpha-fetoprotein, performance status, liver function class). In the validation cohort, ALBI-6 achieved a concordance index of 0.716 and separated patients into three risk groups with significantly different survival (log-rank p = 0.002); ALBI-6 was significantly more discriminative than one comparator score (modified albumin-bilirubin grade, p = 0.040), with numerically higher performance than the remaining comparators. In a separate analysis of the full cohort, ALBI-6 significantly outperformed the CRAFITY score at all assessed time points. Bootstrap validation confirmed model stability.

CONCLUSIONS

ALBI-6 integrates systemic inflammation and liver function into a simple composite index enabling meaningful risk stratification in patients with advanced hepatocellular carcinoma treated with immunotherapy. Prospective external validation is warranted.