ALBI Grade and Sarcopenia in Unresectable HCC: IJG | July 2026

Introduction:

Prognosis in unresectable hepatocellular carcinoma (HCC) depends not only on tumor burden but also on liver function and nutritional status. This study evaluated the prognostic value of ALBI grade, EZ-ALBI grade, and sarcopenia in patients with intermediate- and advanced-stage HCC treated with TACE alone or TACE plus lenvatinib.

Why was this study needed?

• Reliable prognostic markers are needed to personalize treatment in unresectable HCC.
• ALBI and EZ-ALBI provide objective assessment of liver function.
• Sarcopenia is increasingly recognized as an important determinant of cancer outcomes.
• Their combined prognostic value in TACE-based therapy remains unclear.
• Better risk stratification may improve treatment selection and follow-up.

Results:

• ALBI and EZ-ALBI grades accurately predicted treatment response, disease progression, and progression-free survival in both intermediate-stage HCC treated with TACE and advanced-stage HCC treated with TACE plus lenvatinib.
• Sarcopenia was associated with poorer treatment response and shorter progression-free survival in advanced HCC, but showed limited prognostic value in intermediate-stage disease treated with TACE alone.
• These findings highlight the complementary role of liver reserve and muscle mass in predicting outcomes after locoregional and systemic therapy.

Clinical Impact:

Routine assessment of ALBI/EZ-ALBI grades and sarcopenia may improve prognostic stratification in unresectable HCC. While ALBI-based scores appear useful across disease stages, assessment of sarcopenia may be particularly valuable in patients receiving combination therapy with TACE and lenvatinib.

Bottom Line:

ALBI and EZ-ALBI are simple, effective prognostic tools for unresectable HCC. In advanced disease, sarcopenia identifies patients with poorer outcomes, emphasizing the importance of integrating nutritional and functional assessment into routine HCC management.