ALBI ‐6—A Novel Prognostic Score Combining ALBI and Interleukin‐6 in Patients With HCC Treated With Atezolizumab and Bevacizumab

Abstract

BACKGROUND/AIMS: Despite widespread use of combination immunotherapy in advanced liver cancer, reliable biomarkers for baseline risk stratification remain lacking. The inflammatory cytokine interleukin-6 has established prognostic relevance in this cancer. We investigated the prognostic value of interleukin-6 and developed a combined score (ALBI-6) integrating interleukin-6 with albumin-bilirubin grade, a marker of liver function. METHODS: In this multicentre retrospective cohort study, 216 patients with advanced hepatocellular carcinoma treated with first-line atezolizumab plus bevacizumab were analysed. Interleukin-6 was measured at baseline, first response, best response, and progression. The cohort was randomly divided into a training set (n = 98) and a validation set (n = 90). ALBI-6 was derived using Cox regression and evaluated against several established prognostic scores. RESULTS: Elevated baseline interleukin-6 was consistently associated with worse overall survival and remained independently prognostic after adjustment for tumour and clinical factors (extrahepatic spread, vascular invasion, alpha-fetoprotein, performance status, liver function class). In the validation cohort, ALBI-6 achieved a concordance index of 0.716 and separated patients into three risk groups with significantly different survival (log-rank p = 0.002); ALBI-6 was significantly more discriminative than one comparator score (modified albumin-bilirubin grade, p = 0.040), with numerically higher performance than the remaining comparators. In a separate analysis of the full cohort, ALBI-6 significantly outperformed the CRAFITY score at all assessed time points. Bootstrap validation confirmed model stability. CONCLUSIONS: ALBI-6 integrates systemic inflammation and liver function into a simple composite index enabling meaningful risk stratification in patients with advanced hepatocellular carcinoma treated with immunotherapy. Prospective external validation is warranted.

The authors' abstract, as published at the source. Alimentary Pharmacology & Therapeutics, 2026 · DOI ↗