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To assess the utility of the ALBI-Sarcopenia score in predicting the success of HCC treatment. A prospective study involving 262 liver cirrhosis with HCC patients were assigned to various treatment strategies according to Barcelona clinics of liver disease (BCLC) classification. Patients were followed up for 12 months reporting laboratory data, sarcopenia, ALBI-Sarcopenia score, and outcomes. Sarcopenia was prevalent in 43.1% (48.35% males and 31.25% females, <jats:italic>P<\/jats:italic>\u2009=\u20090.042). Most patients were HCV-positive (88.9%) and classified as CTP A (55.7%) or BCLC B (54.2%). Over the study period, TACE was the most administered treatment (41.2% at baseline), followed by a progressive shift toward best supportive care as disease severity increased. Complete response rates declined from 31.7% at 1 month to 21.4% at 12 months, while progressive disease rates increased from 21.8 to 37.8% over the same period. At 12 months, the ALBI-Sarcopenia score demonstrated the highest predictive accuracy for treatment response (AUC:0.69, <jats:italic>p<\/jats:italic>\u2009=\u20090.001), outperforming both the ALBI (AUC: 0.631, <jats:italic>p<\/jats:italic>\u2009=\u20090.001) and MELD (AUC:0.623, <jats:italic>p<\/jats:italic>\u2009=\u20090.003) scores. Logistic regression identified ALBI-Sarcopenia as a significant independent predictor of response at 1 month (OR:1.25, 95% CI:0.881\u20131.971, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) and 12 months (OR:2.189, 95% CI:0.992\u20134.937, <jats:italic>p<\/jats:italic>\u2009=\u20090.001). The ALBI-Sarcopenia score is a robust predictor of treatment outcomes in HCC, offering superior prognostic accuracy compared to traditional scoring systems, and enhancing patient stratification for optimized treatment planning.<\/jats:p>","DOI":"10.1038\/s41598-025-97295-7","type":"journal-article","created":{"date-parts":[[2025,4,26]],"date-time":"2025-04-26T06:00:05Z","timestamp":1745647205000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["ALBI-sarcopenia score as a predictor of treatment outcomes in hepatocellular carcinoma"],"prefix":"10.1038","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-1547","authenticated-orcid":false,"given":"Maha","family":"Elsabaawy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanaa","family":"Badran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Ragab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Abdelhafiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madiha","family":"Nageeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reham","family":"Ashour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,26]]},"reference":[{"issue":"1","key":"97295_CR1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1038\/s41572-020-00240-3","volume":"7","author":"JM Llovet","year":"2021","unstructured":"Llovet, J. 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Ethics approval: NLI IRB 00014014\/FWA00034015 on July 2023, National Liver Institute, Menoufia University, Egypt.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"14621"}}