Albi score predicts overall survival (OS) in patients with hepatocellular carcinoma (HCC) treated with selective internal radiation therapy (SIRT)

We aimed to evaluate the prognostic impact of baseline clinical features and treatment procedure, including liver function measured with albumin-bilirubin (ALBI) formula and dosing methods in HCC patients treated with SIRT. The study includes 82 consecutive patients with liver-dominant HCC treated with SIRT ( Y glass microspheres, TheraSphereTM) between October 2014 and September 2023. Twenty-five patients were treated with standard dosimetry, while for remaining patients, multi-compartment dosimetry was performed using Simplicit90YTM software. Impact of baseline patient's characteristics including presence of portal vein thrombosis (PVT), Child-Pugh score (CP), ALBI score, bilirubin levels, tumor size and prior locoregional liver-directed or systemic treatments was assessed through multivariable Cox proportional hazard model. Median follow-up after treatment was 40.0 months (15.2-67.9). At univariable analysis, ALBI score and bilirubin levels were found to be independent prognostic factors for survival after SIRT (p = 0.001, respectively); furthermore, at Cox proportional hazards analysis, HR for death of ALBI 2 versus ALBI 1 was 10.54 (95% CI, 1.42-78.19, p = 0.021), while despite not significant, HR in patients with bilirubin levels over 1.1 mg/dl was 2.67 (0.75-9.44, p = 0.118). Conversely, no significant association was found between OS and cirrhosis, tumor size and PVT. ALBI score demonstrated to impact OS in HCC patients treated with SIRT thus going beyond a simple prediction of treatment-related toxicity. The present results are relevant for the selection of HCC patients for SIRT in a real-world clinical setting.