Clinical usefulness of newly developed prognostic predictive score for atezolizumab plus bevacizumab for hepatocellular carcinoma.

Hideko Ohama,Satoshi Yasuda,Masaki Kaibori,Taeang Arai,Tomomi Okubo,Kazuhito Kawata,Ei Itobayashi,Kazuhiro Nouso,Toshifumi Tada,Noritomo Shimada,Yutaka Yata,Hironori Ochi,Joji Tani,Yohei Koizumi,Kazuya Kariyama,Kunihiko Tsuji,Takeshi Hatanaka,Chikara Ogawa,Norio Itokawa,Satoru Kakizaki,Akemi Tsutsui,Shinya Fukunishi,Hisashi Kosaka,Keisuke Yokohama,Yoichi Hiasa,Masashi Hirooka,Michitaka Imai,Toru Ishikawa,Fujimasa Tada,Hiroko Iijima,Hidenori Toyoda,Tomomitsu Matono,Masanori Atsukawa,Hiroki Nishikawa,Hidekatsu Kuroda,Takashi Kumada,Asahiro Morishita,Shinichiro Nakamura,Takuya Nagano,Takashi Nishimura,Atsushi Naganuma,Koichi Takaguchi,Kazuto Tajiri,Atsushi Hiraoka

doi:10.1002/cnr2.2042

Abstract

The aim of the present study was to elucidate detailed parameters for prediction of prognosis for patients with unresectable hepatocellular carcinoma (uHCC) receiving atezolizumab plus bevacizumab (Atez/Bev) treatment. A total of 719 patients (males 577, median age 74 years) treated with Atez/Bev between September 2020 and January 2023 were enrolled. Factors related to overall survival (OS) were extracted and a prognostic scoring system based on hazard ratio (HR) was created. OS and progression-free survival (PFS) were retrospectively examined, and the prognostic ability of the newly developed system was compared to CRAFITY score using concordance index (c-index) and Akaike information criterion (AIC) 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 to develop the IMmunotherapy with AFP, BCLC staging, mALBI, and DCP evaluation (IMABALI-De) scoring system. For IMABALI-De scores of 0, 1, 2, 3, 4, and 5, OS was not applicable (NA), NA, 26.11, 18.79, 14.07, and 8.32 months, respectively (p < .001; AIC 2788.67, c-index 0.699), while for CRAFITY scores of 0, 1, and 2, OS was 26.11, 20.29, and 11.32 months, respectively (p < .001; AIC 2864.54, c-index 0.606). PFS periods for those IMABALI-De scores were 21.75, 12.89, 9.18, 8.0, 5.0, and 3.75 months, respectively (p < .001; AIC 5203.32, c-index 0.623) and for the CRAFITY scores were 10.32, 7.68, and 3.57 months, respectively (p < .001; AIC 5246.61, c-index 0.574). As compared with CRAFITY score, IMABALI-De score had better AIC and c-index results for both OS and PFS. The present results indicated that the proposed IMABALI-De score may be favorable for predicting prognosis of uHCC patients receiving Atez/Bev therapy.

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