Validation of the CRAFITY score for predicting prognosis in patients with hepatocellular carcinoma undergoing transarterial chemoembolization combined with systemic therapy

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BackgroundThe CRAFITY score can predict survival and radiological response to systemic front-line treatment in patient with hepatocellular carcinoma (HCC). AimsIn this study, we aimed to externally validate the CRAFITY score and compare it with other simple prognostic models in patients with unresectable HCC who underwent transarterial chemoembolization (TACE) combined with systemic therapies. MethodsPatients with unresectable HCC who underwent TACE combined with tyrosine kinase inhibitors (TKIs), with or without immune checkpoint inhibitors (ICIs), were retrospectively analyzed to determine whether the CRAFITY score can predict overall survival (OS) through multivariate analysis and Kaplan‒Meier curves. Prediction of 3- and 6-month objective response rates (ORRs) was validated by the area under the curve (AUC). ResultsAmong 147 patients with unresectable HCC, 113 received TACE ​+ ​TKI and 34 received TACE ​+ ​TKI ​+ ​ICI. The CRAFITY score was identified as an independent predictor for OS (P ​< ​0.001) and showed a good ability to categorize all included patients into low-, moderate-, and high-risk groups (P ​< ​0.001). For predicting the 3- and 6-month ORRs, the CRAFITY score exhibited poor performance, with AUCs of 0.555 and 0.515, respectively. ConclusionThe CRAFITY score is effective in predicting OS but demonstrates limited accuracy in predicting 3- and 6-month ORRs for patients with unresectable HCC undergoing TACE combined with systemic therapies.