Validation of the Up7-ALBI Score for Prognostication in Unresectable Hepatocellular Carcinoma Treated with Atezolizumab Plus Bevacizumab

Purpose

A well-established prognostic scoring system for unresectable hepatocellular carcinoma (uHCC) receiving systemic therapy is lacking. The Up7-ALBI score has shown prognostic value for lenvatinib. This study aimed to validate its prognostic value in uHCC treated with atezolizumab plus bevacizumab (atezo-bev). Patients and Methods: This retrospective multicenter study included 225 patients with uHCC who received first-line atezo-bev in Taiwan between 2017 and 2025. The Up7-ALBI score (0– 2), combining tumor burden (within vs beyond up-to-7) and ALBI grade (1 vs 2– 3), categorized patients into low-, intermediate-, and high-risk groups. The score was used to stratify progression-free survival (PFS) and overall survival (OS), with multivariate Cox analysis performed. Prognostic performance was compared with previously reported scoring systems.