Examining ALBI Grade and Portal Vein Thrombosis in Frontline HCC Treatment

In this discussion, the expert panel debates how liver-function assessment should guide frontline therapy in advanced hepatocellular carcinoma (HCC). The Team Chicago Hot Dog physicians question Team Deep-Dish Pizza about the role of ALBI grade versus the more familiar Child-Pugh score, and James J. Harding, MD, and Lipika Goyal, MD, explain that ALBI relies on objective albumin and bilirubin values and better differentiates outcomes within Child-Pugh class A. The panel notes that 40% to 50% of Child-Pugh A patients may be ALBI grade 2, with a worse prognosis, underscoring the importance of liver reserve in treatment selection. The conversation then turns to patients with main portal vein thrombosis, who were excluded from HIMALAYA. Harding stresses multidisciplinary management, the poor prognosis of Vp4 disease, and the value of repeat variceal screening, framing how clinicians individualize frontline decisions for higher-risk advanced HCC populations seen in routine practice.