Prognostic Model Based on Sex, ALBI Grade, and ALR in Intermediate-to-Advanced HCC Patients Receiving Targeted Therapy Combined with ICIs and Interventional Treatment

Background/Objectives: Triple therapy combining targeted therapy (lenvatinib/bevacizumab), immune checkpoint inhibitors (ICIs), and interventional therapy (TACE/HAIC) has shown promising efficacy, but clinical outcomes differ among patients. We developed and tested a prognostic model based on sex, ALBI grade, and ALR to estimate survival in patients with intermediate-to-advanced HCC receiving triple therapy. Methods: This single center retrospective study included 184 intermediate-to-advanced HCC patients between November 2017 and December 2024. The patients enrolled received lenvatinib (n = 88) or bevacizumab (n = 96) plus PD-1/PD-L1 inhibitors and interventional therapy. The risk scoring model was derived from univariate Cox regression, LASSO Cox regression, and multivariate Cox regression analyses that were screened for independent prognostic factors. The median risk score defined the cutoff for separating patients into two risk subgroups (high- and low-risk). Overall survival (OS) across subgroups was evaluated and compared by Kaplan–Meier analysis and log-rank test. Model performance was evaluated using the C-index, time-dependent AUC at 6, 12, and 24 months, calibration curves, the Brier score, and decision curve analysis, with internal validation performed via Bootstrap resampling. Results: Multivariate analysis identified male sex, ALBI grade 3, and a high ALR level as independent risk factors of poorer OS. The resulting risk model showed a C-index of 0.62. Moreover, the median OS differed significantly between the two risk groups (p < 0.001). The model displayed moderate discrimination, with AUCs of 0.66, 0.66, and 0.74 at 6, 12, and 24 months. Calibration and the Brier score showed reasonable agreement and acceptable prediction errors. No interaction between risk factors and treatment type was observed (p > 0.05), indicating model applicability to both lenvatinib and bevacizumab-based regimens. Conclusions: A prognostic model integrating sex, ALBI grade, and ALR can offer some capacity to stratify survival risk in intermediate-to-advanced HCC patients. However, its overall discriminative performance is limited, and further validation in larger and external cohorts is needed to confirm its clinical value.