Impact of albumin-bilirubin score change on prognosis in hepatocellular carcinomia treated with tyrosine kinase inhibitors: a single-center real-world study

Background/Aims: Liver function deterioration during treatment with tyrosine kinase inhibitors (TKIs) affects overall survival (OS) prognosis in patients with advanced hepatocellular carcinoma (HCC). This study aimed to monitor the dynamic changes in the albumin-bilirubin (ALBI) score to assess liver function deterioration during first-line treatment with sorafenib or lenvatinib and to evaluate its prognostic value for OS. Methods: A retrospective cohort study was conducted on 73 patients with unresectable advanced HCC who received lenvatinib or sorafenib from 2022 to 2025 at Ho Chi Minh City Oncology Hospital, Vietnam. Changes in the ALBI score were recorded monthly and analyzed using the Wilcoxon signed-rank test. Cox regression models were used to identify factors affecting OS and progression-free survival (PFS), which were analyzed using the Kaplan-Meier method, stratified by ALBI grade. Results: During the 6 month follow-up period, the median ALBI score increased significantly compared with baseline (p<0.05), indicating liver function deterioration. This deterioration was observed in both patients with progressive disease (ALBI increased from -2.64 to -2.02; p<0.0001) and those with stable disease (ALBI increased from -2.77 to -2.46; p=0.003). The median OS was 13 months, with significant differences according to baseline ALBI grade (grade 1: 16 months; grade 2a: 10 months; grade 2b: 8 months; p = 0.042). The baseline ALBI grade also had prognostic value for PFS in the sorafenib subgroup (p = 0.032). The change in ALBI score (ΔALBI) at month 3 was an independent prognostic factor for OS (p=0.032). Grade ≥3 toxicity was most frequent in the ALBI grade 2b group, with toxicity rates increasing with worsening ALBI grade (p=0.012). Conclusion: The ALBI score is a valuable tool for dynamically monitoring liver function and prognosticating survival in HCC patients receiving first-line TKI therapy. The observed decline in liver function suggests a composite effect of tumor progression and treatment-related toxicity.