The Liver Cancer and Frailty in Elderly (LIFE) study: Longitudinal functional status analysis in patients with advanced hepatocellular carcinoma (HCC) and prognostication.

Abstract

521 Background: The incidence of HCC has tripled over recent decades, with a disproportionately higher burden among older adults. Traditional scoring systems such as the Child-Pugh, Model for End-Stage Liver Disease (MELD), and Albumin-Bilirubin (ALBI) scores have been widely adopted to assess hepatic function and predict mortality. While these scores offer valuable insights, they may not fully capture the functional status and quality of life of patients. Therefore, we conducted an analysis of associations between geriatric assessments and prognostic scoring systems. Methods: Data from a prospective observational study (NCT03894917) of 86 patients with advanced HCC were analyzed. Patients were stratified into two categories: <65 years and ≥65 years. Self-reported assessments of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) were evaluated at baseline. Liver function was characterized using established scoring systems: Child–Pugh, MELD, and ALBI. We further segmented patients by ALBI grades (1-3) to understand its association with ADL/IADL and AST/ALT. Results: Among patients younger than 65 years (n=38) and those aged 65 years or older (n=49), functional status was largely preserved, with median ADL scores of 6 in both cohorts. IADL scores, however, trended higher in the older group. Within the overall cohort (n=86), 23.8% (n=25) identified non-Spanish and 65.6% (n=63) as Spanish/Hispanic/Latino. In patients <65 years, strong positive correlation was observed between the AST/ALT ratio and both ALBI score (r=0.85) and IADL (r=0.99). However, in patients ≥65 years, ALBI grade demonstrated a negative correlation with IADL (r=–0.36). Notably, the strength of associations between biochemical score (ALBI, MELD, Child-Pugh) and functional assessments was greater in the ≥65 years cohort compared with the <65 years. Conclusions: In this cohort of patients with HCC, ALBI grading positively correlated with IADL patients <65 years and negatively in patients ≥65 years. Future studies should explore how ADL and IADL correlate with therapeutic outcomes in advanced HCC, particularly in the context of tyrosine kinase inhibitors (TKIs) versus immuno-oncology (IO) therapies, to better personalize treatment strategies. Combined summary table. Variable <65 years (Median, IQR) ≥65 years (Median, IQR) Age 60.5 (55.0-63.0) 72.0 (68.0-75.0) ALBI Grade Grade 3: 16 (47.1%)Grade 2: 15 (44.1%)Grade 1: 3 (8.8%) Grade 3: 19 (42.2%)Grade 2: 23 (51.1%)Grade 1: 3 (6.7%) MELD 9.0 (7.0-12.0) 10.0 (7.0-12.2) Child-Pugh B7: 7 (24.1%); A5: 7 (24.1%); A6: 6 (20.7%); B9: 4 (13.8%); B8: 3 (10.3%); C11 or more: 2 (6.9%) A5: 12 (37.5%); B7: 9 (28.1%); A6: 6 (18.8%); B8: 2 (6.2%); B9: 1 (3.1%); C10: 1 (3.1%); C11 or more: 1 (3.1%) IADL Score 7.0 (5.0-8.0) 8.0 (7.0-8.0) ADL Score 6.0 (5.0-6.0) 6.0 (6.0-6.0)