Work

#1 - Clinically Significant Portal Hypertension, Rather Than Albi Grade, Is the Most Relevant Prognostic Factor in Patients Receiving Systemic Therapy for Hepatocellular Carcinoma

Year: 2026

Type: article

Abstract: Introduction and Objectives In recent clinical trials of patients with advanced hepatocellular carcinoma (HCC) treated with systemic therapy, Child-Pugh A score was used as an eligibility criterion. However, this score has been extrapolated to non-cirrhotic populations. We aimed to compare the roles of different prognostic models in patients with advanced HCC, particularly Child–Pugh A patients with or without cirrhosis. Patients and Methods A prospective, multicenter cohort study was conducted between 2018 and 2024 in Argentina, Chile, Brazil, and Colombia, including patients with BCLC stage B or C HCC treated with systemic therapy. Cirrhosis was defined clinically using laboratory and imaging data or concomitant non-invasive tests, or histologically confirmed. We estimated the instantaneous risk of death (hazard ratio, HR) with 95% confidence intervals (95% CI) using a Cox proportional hazards model. Results Of 306 patients who started systemic therapy (BCLC stage B, 27%, and C, 73%), 83.3% had cirrhosis (n=255). Patients with cirrhosis had worse survival (median 13.6 months) than those without cirrhosis (21.7 months; P=0.016), particularly those with clinically significant portal hypertension (CSPH) (HR 1.53 [CI 1.11–2.12]). Among Child-Pugh A patients (n=242), the ALBI score did not discriminate prognosis, either in those with and without cirrhosis. In a final multivariable Cox model among Child–Pugh A patients with or without cirrhosis, atezolizumab + bevacizumab (HR 0.64 [95% CI 0.42-0.99]), adjusted for serum alpha-fetoprotein value 400 ng/ml, and for the presence of CSPH were independent prognostic variables. Conclusions Accurate reporting of cirrhosis is crucial due to its independent prognostic impact and potential imbalance without stratification.

Source: Annals of Hepatology

DOI: 10.1016/j.aohep.2026.102286