Background: Selective internal radiation therapy (SIRT) is an innovative treatment of hepatocellular carcinoma (HCC). The albumin-bilirubin (ALBI) score was designed to better evaluate liver functions in HCC. Methods: We studied, retrospectively, data from patients treated with SIRT for HCC. The primary endpoint was the occurrence of radioembolization-induced liver disease (REILD). The secondary endpoint was overall survival (OS). Results: 222 patients were studied. The ALBI grade 1 patients had significantly less REILD (3.4%) after the first SIRT than ALBI grade 2 or 3 patients (16.8%, p = 0.002). Of the 207 patients with data, 77 (37.2%) had a worsening of ALBI grade after one SIRT. The baseline ALBI grade was significantly associated with OS (p = 0.001), also in the multivariable analysis. The ALBI grade after the first SIRT was significantly associated with OS (p ≤ 0.001), with median OS of 26.4 months (CI 95% 18.2–34.7) for ALBI grade 1 patients (n = 48) versus 17.3 months (CI 95% 12.9–21.8) for ALBI grade 2 patients (n = 123) and 8.1 months (CI 95% 4.1–12.1) for ALBI grade 3 patients (n = 36). Conclusions: The baseline ALBI grade is a strong predictor of REILD. The baseline ALBI score and variations of ALBI are prognostic after SIRT.

Quality of life (QoL) in oncology is an outcome becoming more and more important and relevant to explore. Some studies have demonstrated its prognostic impact in different cancers, such as colorectal, breast, and prostate cancers, but also in hepatocellular carcinoma (HCC). Different tools have been developed for assessing quality of life, some general, such as EORTC QLQ-C30, but also specific tools depending on cancer origin which seem to be more pertinent for patients. Systemic treatments and specific symptoms due to cancer evolution could decrease quality of life. For approval of new systemic treatments, authorities ask for benefit in terms of efficacy but also benefit in quality of life, which is crucial for patients. This review reports data about QoL in HCC, including specific tools used, impact of systemic treatments and prognosis for QoL for HCC patients. Management of adverse events is essential to enhance compliance with treatment and quality of life. Assessing quality of life in clinical trials appears quite systematic, but its application in clinical routine requires development.