Clinical usefulness of newly developed prognostic predictive score for
atezolizumab plus bevacizumab for hepatocellular carcinoma
Abstract
Background/Aim: The present study aimed to develop detailed parameters
for prediction of prognosis for patients with unresectable
hepatocellular carcinoma (uHCC) receiving Atezolizumab plus Bevacizumab
(Atez/Bev). Methods: Between September 2020 and January 2023, the
patients treated with Atez/Bev were enrolled (n=719, males 577, median
age 74 years). Factors involved in overall survival (OS) were extracted
and a prognostic scoring system based on hazard ratio (HR) was created.
OS and progression-free survival (PFS) were examined retrospectively,
and the prognostic ability of the newly system was compared to CRAFITY
score using concordance index (c-index) and Akaike Information Criterion
(AIC) results. Results: Cox-hazards multivariate analysis showed BCLC
classification C/D (HR 1.4; 1 point), AFP ≥100 ng/mL (HR 1.4; 1 point),
mALBI 2a (HR 1.7; 1 point), mALBI 2b/3 (HR 2.8; 2 points), and DCP ≥100
mAU/mL (HR 1.6; 1 point) as significant factors. The assigned points
were added and used for IMnunotherapy with AFP, BCLC staging, mALBI, and
DCP evaluation (IMABALI-De) scoring. For IMABALI-De scores of
0/1/2/3/4/5, OS was not applicable (NA)/NA/26.11/18.79/14.07/8.32 months
(P<0.001; AIC 2788.67, c-index 0.699), while for CRAFITY
scores of 0/1/2, OS was 26.11/20.29/11.32 months (p<0.001; AIC
2864.54, c-index 0.606). PFS for those IMABALI-De scores was
21.75/12.89/9.18/8.0/5.0/3.75 months (P<0.001; AIC 5203.32,
c-index 0.623) and for the CRAFITY scores was10.32/7.68/3.57 months
(p<0.001; AIC 5246.61, c-index 0.574). IMABALI-De score had
better AIC and c-index results as compared to CRAFITY score for both OS
and PFS. Conclusion: The proposed IMABALI-De score may have a favorable
prognostic predictive ability for uHCC patients with Atez/Bev.