Prognostic Value of Changes in Combined Child–Pugh Class and ALBI Grade in Hepatocellular Carcinoma Treated with Transcatheter Intra-Arterial Therapy Plus Targeted Therapy and PD-(L)1 Inhibitors

Xiaoyu Huang,* Xiaojing Cao,* Yaqing Kong, Fan Tang, Tianhao Cong, Xiang Zhou Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiang Zhou, Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China, Email [email protected]: This study aims to investigate liver function changes in hepatocellular carcinoma (HCC) patients treated with transcatheter intra-arterial therapy plus molecular targeted agents and programmed cell death-1 (ligand-1) inhibitors, and evaluate the prognostic significance of the combination of Child–Pugh (CP) class and albumin-bilirubin (ALBI) grade (CP/ALBI).Methods: This is a retrospective study. A total of 149 patients from 2019 to 2023 in China were included. Changes in CP score, ALBI grade, and CP/ALBI grade at 4– 8 weeks, 12– 16 weeks, and 20– 28 weeks post-treatment was evaluated. Cox regression models identified prognostic factors for overall survival (OS) and progression-free survival (PFS). The discrimination of the scoring systems was determined by concordance index (C-index) and time-dependent area under the receiver operating characteristic curve (AUC).Results: Among CP-A patients (n = 137), 11.68% (n = 16) progressed to CP-B by 20– 28 weeks (p < 0.001). Multivariate analysis identified CP/ALBI grade at 20– 28 weeks as an independent prognostic factor for OS (grade 2 vs grade 1, hazard ratio [HR] 3.12, p < 0.001; grade 3 vs grade 1, HR 4.95, p < 0.001) and at 4– 8 weeks for PFS (grade 3 vs grade 1, HR 3.26, p = 0.002). The combination of CP/ALBI grade and baseline clinical prognostic factors (Eastern Cooperative Oncology Group Performance Status, Barcelona Clinic Liver Cancer stage, tumor size) demonstrated superior discrimination for OS (C-index: 0.74– 0.77; time-dependent AUC: 0.74– 0.92). Baseline factors associated with maintaining CP/ALBI grade 1 in CP-A patients included ALBI grade 1 (odds ratio [OR] 3.09, p = 0.030) and aspartate aminotransferase < 40 U/L (OR 3.35, p = 0.017).Conclusion: A small but notable proportion of HCC patients experienced liver function deterioration within 28-week of combined treatment. Dynamic monitoring of CP/ALBI grade provides valuable prognostic insights for patient stratification.Keywords: transarterial chemoembolization, hepatic arterial infusion chemotherapy, tyrosine kinase inhibitors, immunotherapy, child–Pugh score, albumin-bilirubin grade