Reliable Performance of mALBI Grade-Based Risk Models for Predicting the Prognosis of Patients With Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab as First-Line Treatment: Comparative Analysis of 13 Risk Models

Takeshi Hatanaka; Satoru Kakizaki; Atsushi Hiraoka; Toshifumi Tada; Masashi Hirooka; Kazuya Kariyama; Joji Tani; Masanori Atsukawa; Koichi Takaguchi; Ei Itobayashi; Shinya Fukunishi; Kunihiko Tsuji; Toru Ishikawa; Kazuto Tajiri; Hidenori Toyoda; Chikara Ogawa; Hiroki Nishikawa; Takashi Nishimura; Kazuhito Kawata; Hisashi Kosaka; Atsushi Naganuma; Yutaka Yata; Hideko Ohama; Hidekatsu Kuroda; Tomomitsu Matono; Kazunari Tanaka; Fujimasa Tada; Kazuhiro Nouso; Asahiro Morishita; Akemi Tsutsui; Takuya Nagano; Norio Itokawa; Tomomi Okubo; Taeang Arai; Michitaka Imai; Yohei Koizumi; Shinichiro Nakamura; Masaki Kaibori; Hiroko Iijima; Yoichi Hiasa; Takashi Kumada; Real‐life Practice Experts for HCC (RELPEC) Study Group, and HCC 48 Group (hepatocellular carcinoma experts from 48 clinics in Japan)

doi:10.1111/jgh.16871

Reliable Performance of mALBI Grade-Based Risk Models for Predicting the Prognosis of Patients With Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab as First-Line Treatment: Comparative Analysis of 13 Risk Models

J Gastroenterol Hepatol. 2025 Jan 6. doi: 10.1111/jgh.16871. Online ahead of print.

Authors

Takeshi Hatanaka¹, Satoru Kakizaki^{2

3}, Atsushi Hiraoka⁴, Toshifumi Tada⁵, Masashi Hirooka⁶, Kazuya Kariyama⁷, Joji Tani⁸, Masanori Atsukawa⁹, Koichi Takaguchi¹⁰, Ei Itobayashi¹¹, Shinya Fukunishi¹², Kunihiko Tsuji¹³, Toru Ishikawa¹⁴, Kazuto Tajiri¹⁵, Hidenori Toyoda¹⁶, Chikara Ogawa¹⁷, Hiroki Nishikawa¹⁸, Takashi Nishimura¹², Kazuhito Kawata¹⁹, Hisashi Kosaka²⁰, Atsushi Naganuma²¹, Yutaka Yata²², Hideko Ohama²³, Hidekatsu Kuroda²⁴, Tomomitsu Matono²⁵, Kazunari Tanaka¹³, Fujimasa Tada⁴, Kazuhiro Nouso⁷, Asahiro Morishita⁸, Akemi Tsutsui¹⁰, Takuya Nagano¹⁰, Norio Itokawa⁹, Tomomi Okubo⁹, Taeang Arai⁹, Michitaka Imai¹⁴, Yohei Koizumi⁶, Shinichiro Nakamura⁵, Masaki Kaibori²⁰, Hiroko Iijima¹², Yoichi Hiasa⁶, Takashi Kumada²⁶; Real‐life Practice Experts for HCC (RELPEC) Study Group, and HCC 48 Group (hepatocellular carcinoma experts from 48 clinics in Japan)

Affiliations

¹ Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan.
² Department of Clinical Research, NHO Takasaki General Medical Center, Takasaki, Japan.
³ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁴ Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan.
⁵ Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Himeji, Japan.
⁶ Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Matsuyama, Japan.
⁷ Department of Gastroenterology, Okayama City Hospital, Okayama, Japan.
⁸ Department of Gastroenterology and Neurology, Kagawa University, Kita-gun, Japan.
⁹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
¹⁰ Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
¹¹ Department of Gastroenterology, Asahi General Hospital, Asahi, Japan.
¹² Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Diseases, Hyogo Medical University, Nishinomiya, Japan.
¹³ Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
¹⁴ Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan.
¹⁵ Department of Gastroenterology, Toyama University Hospital, Toyama, Japan.
¹⁶ Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
¹⁷ Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Takamatsu, Japan.
¹⁸ Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
¹⁹ Hepatology Division, Department of Internal Medicine II, Hamamatsu University School of Medicine, Hamamatsu, Japan.
²⁰ Department of Surgery, Kansai Medical University, Hirakata, Japan.
²¹ Department of Gastroenterology, NHO Takasaki General Medical Center, Takasaki, Japan.
²² Department of Gastroenterology, Hanwa Memorial Hospital, Osaka, Japan.
²³ Department of Gastroenterology, Takarazuka City Hospital, Takarazuka, Japan.
²⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
²⁵ Department of Gastroenterology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan.
²⁶ Department of Nursing, Gifu Kyoritsu University, Ogaki, Japan.

PMID: 39762722
DOI: 10.1111/jgh.16871

Abstract

Aim: This study aimed to compare the prognostic performance of the risk models for patients with hepatocellular carcinoma (HCC) receiving atezolizumab and bevacizumab (Atez/Bev) as first-line treatment.

Methods: Among 449 patients included in this retrospective multicenter study, we compared the prognostic performance of 13 risk models for the 12-month and 18-month survival status using area under the curve (AUC), net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI) analysis. We also constructed a calibration plot to assess the fitness of each model.

Results: Regarding the analysis of the 12-month survival status, none of the risk models demonstrated AUC values higher than the modified albumin-bilirubin (mALBI) grade. In the NRI analysis, only the IMmunotherapy with AFP, BCLC staging, mALBI, and DCP evaluation (IMABALI-De score) exhibited a statistically significant improvement compared with the mALBI grade (p = 0.009). While the modified albumin-bilirubin grade (mALF) score and prognostic nutritional index (PNI) did not exhibit significant differences compared to the mALBI grade (p = 0.3 and 0.2, respectively), the remaining risk models were inferior to the mALBI grade. In the relative IDI analysis, none of the risk models showed a significant improvement compared with the mALBI grade. The calibration plot of the PNI was unsatisfactory. The results for the 18-month survival status were consistent with those for the 12-month survival status. A time-dependent ROC analysis demonstrated that both the mALBI grade and the mALBI-based model showed consistent performance over time.

Conclusions: The mALBI grade, as well as the IMABALI-De and mALF scores (both of which are risk models based on mALBI grade), exhibited reliable performance in predicting the prognosis of patients with HCC.

Keywords: ALBS grade; CRAFITY score; Glasgow prognostic score; HCC‐GRIm score; IMABALI‐De score; geriatric nutritional risk index; mALF score; neo‐GPS; neutrophil to lymphocyte ratio; prognostic nutritional index.