A simple ABC score for prognosis stratification and treatment selection in advanced hepatocellular carcinoma.

511 Background: Atezolizumab plus bevacizumab (A+B) is widely used as a standard first-line therapy for advanced hepatocellular carcinoma (HCC), while lenvatinib (L) and lenvatinib plus immunotherapy (L+I) remain common alternatives in clinical practice. Some patients have poor responses to A+B, and predictive biomarkers are lacking. We aimed to develop a simple blood-based prognostic score to aid in prognosis stratification and clinical decision-making. Methods: This retrospective international study included HCC patients treated with A+B, L, or L+I at 11 hospitals in Japan and 15 hospitals in Taiwan. Cox regression analysis was used to identify key prognostic factors for overall survival (OS). Results: Between September 2017 and March 2024, 1442 HCC patients were included, with a median age of 67.9 years and 77.7% being male. Multivariable analysis identified three independent poor prognostic factors, which were integrated into the ABC score: baseline (A)lpha-fetoprotein >20 ng/mL (hazard ratio [HR] 1.79; p