Prognostic value of albumin-bilirubin score in hepatocellular carcinoma patients treated with Lenvatinib: A Real-world South Indian cohort study

Background In advanced hepatocellular carcinoma (HCC), baseline liver function is crucial for predicting survival, therapeutic effectiveness, and safety outcomes. A proven, objective indicator of hepatic reserve, the albumin–bilirubin (ALBI) score may be a better indicator of prognosis for patients undergoing systemic therapy. Objective This study examines the effects of baseline Child Pugh score and ALBI grade on patients with hepatocellular cancer who were treated with lenvatinib. Methods All patients who received lenvatinib as a first- or second-line therapy for advanced HCC at our hospital between 2020 and 2024 were included in this retrospective study. The Child-Pugh score and ALBI grade were used to classify baseline liver function. The objective response rate (mRECIST), time to treatment failure (TTF), progression-free survival (PFS), overall survival (OS), and treatment discontinuation due to adverse events (AEs) were the primary outcomes evaluated. The patients were divided into four groups: Child-Pugh A5/ALBI 1, Child-Pugh A5/ALBI 2, Child-Pugh A6, and Child-Pugh ≥ 7. To identify determinants of response and discontinuation, univariate and multivariate analyses were conducted. Results The cohort's median overall survival (OS) and progression-free survival (PFS) were 27.4 months and 13.5 months, respectively. The OS (38.4 vs. 20.4 months) and PFS (15.3 vs. 11.5 months) of patients with ALBI grade 1 were considerably longer. Group 4 had the lowest survival rate, while Group 1 had the highest. The most frequent adverse events were fatigue (30%) and anorexia (22%). Disease progression was independently predicted by higher initial dosages and extrahepatic distribution. Conclusion The prognosis of HCC patients on lenvatinib was effectively stratified by baseline ALBI grade. The higher survival and tolerability of patients with preserved liver function (ALBI grade 1) suggest ALBI as a crucial adjunct to the Child-Pugh score in treatment planning.