A simple ABC score for prognosis stratification and treatment selection in advanced hepatocellular carcinoma.
Year: 2026
Type: conference-abstract
Abstract: 511 Background: Atezolizumab plus bevacizumab (A+B) is widely used as a standard first-line therapy for advanced hepatocellular carcinoma (HCC), while lenvatinib (L) and lenvatinib plus immunotherapy (L+I) remain common alternatives in clinical practice. Some patients have poor responses to A+B, and predictive biomarkers are lacking. We aimed to develop a simple blood-based prognostic score to aid in prognosis stratification and clinical decision-making. Methods: This retrospective international study included HCC patients treated with A+B, L, or L+I at 11 hospitals in Japan and 15 hospitals in Taiwan. Cox regression analysis was used to identify key prognostic factors for overall survival (OS). Results: Between September 2017 and March 2024, 1442 HCC patients were included, with a median age of 67.9 years and 77.7% being male. Multivariable analysis identified three independent poor prognostic factors, which were integrated into the ABC score: baseline (A)lpha-fetoprotein >20 ng/mL (hazard ratio [HR] 1.79; p<0.001), al(B)umin <3.5 g/dL (HR 1.71; p<0.001), and (C)hronic inflammation (neutrophil-to-lymphocyte ratio [NLR] >4; HR 1.50; p<0.001). Patients were distributed among ABC scores of 0 (242; 16.8%), 1 (551; 38.2%), 2 (483; 33.5%), and 3 (166; 11.5%), with corresponding median OS of 40.3, 22.7, 12.0, and 8.0 months, respectively (P<0.001). In the entire cohort, OS was similar across treatment regimens (median OS: 16.5 months for A+B, 20.1 months for L, and 17.7 months for L+I; P=0.087). However, among the 649 (45%) high-risk patients (ABC score 2–3), those treated with lenvatinib-based therapies had significantly better OS (median OS: 8.4 months for A+B, 11.0 months for L, and 13.7 months for L+I; P=0.0039). Conclusions: The ABC score is a simple and robust tool associated with survival in patients receiving first-line A+B or lenvatinib-based therapy. It may facilitate prognosis stratification and help clinical decision-making, but requires prospective validation. Multivariable Cox regression for overall survival. Variables HR 95% CI p-value Age 1.01 1.00–1.02 0.008 Sex (male vs. female) 0.87 0.73–1.03 0.106 ECOG Performance Status 0 — — — 1 1.35 1.15–1.59 <0.001 ≥2 1.89 1.46–2.44 <0.001 Vascular invasion (Yes vs. No) 1.50 1.27–1.76 <0.001 Extrahepatic spread (Yes vs. No) 1.21 1.04–1.41 0.014 AFP≥20 ng/ml (Yes vs. No) 1.79 1.52–2.11 <0.001 Albumin ≤ 3.5 g/dL (Yes vs. No) 1.71 1.46–1.99 <0.001 NLR≥4 (Yes vs. No) 1.50 1.29–1.75 <0.001 First-line treatment Lenvatinib + Immunotherapy — — — Lenvatinib monotherapy 0.83 0.66–1.03 0.090 Atezolizumab + bevacizumab 1.14 0.89–1.45 0.301 ECOG Performance Status: Eastern Cooperative Oncology Group Performance Status; AFP: alpha-fetoprotein; NLR: neutrop
Source: Journal of Clinical Oncology
Authors: Yung-Yeh Su, Masayuki Ueno, Po Ting Lin, Pei-Chang Lee, Hiroki Morimura, Hong Wei Wang, Norihiro Nishijima, Ching-Wei Chang, Satoru Iwamoto, Shu Nagatomo, Takeshi Mitani, Teng-Yu Lee, Haruhiko Takeda, Atsushi Takai, Hsueh-Chou Lai, Hiroshi Seno, Ying-Chun Shen, Shi-Ming Lin, Yi-Hsiang Huang, Li-Tzong Chen
Institutions: National Health Research Institutes, Kyoto University, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taipei Veterans General Hospital, Osaka Red Cross Hospital, China Medical University Hospital, Meiwa Hospital, Mackay Memorial Hospital, Kyoto Medical Center, Tenri Hospital, Kurashiki Central Hospital, Taichung Veterans General Hospital, National Taiwan University, Kaohsiung Medical University, Kaohsiung Medical University Chung-Ho Memorial Hospital
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7122679549