Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
J Med Imaging Radiat Oncol. 2022 Aug;66(5):662-670. doi: 10.1111/1754-9485.13398. Epub 2022 Mar 3.
We aimed to explore the prognostic value of albumin-bilirubin (ALBI) scores in unresectable hepatocellular carcinoma (HCC) treated with combined immune checkpoint inhibitors (ICIs) and radiotherapy (RT).
Patients with unresectable HCC receiving combined ICI and RT (July 2018 to February 2021) were retrospectively enrolled and analysed. Cox regression modelling was implemented to identify prognostic factors. Survival analysis was performed using the Kaplan-Meier method. Survival was compared using log-rank tests.
A total of 38 patients were enrolled. The median follow-up was 16.5 months (range: 6.7-29.9). The objective response rate (ORR) was 28.9%, including complete response in three (7.9%) patients. The median progression-free survival (PFS) was 5.6 months (95% confidence interval (CI): 3.2-8.0), and the median overall survival (OS) was 12.9 months (95% CI: 8.3-17.6). In the multivariate Cox regression analysis, ALBI score and age were identified as independent prognostic factors for PFS and OS. Patients with grade 1 ALBI scores who were ≥53 years of age (the low-risk group) had statistically significantly higher ORRs (50.0% vs. 13.6%) and prolonged median PFS (15.3 vs. 2.7 months) and OS (not reached vs. 10.1 months). Grade 3 haematological toxicities and/or liver function abnormalities occurred in 15 (39.5%) patients; treatment was not interrupted. No grade 4 or higher side effects were observed.
Combined ICI and RT is an effective modality for treating unresectable HCC with moderate side effects. ALBI scores merits consideration when applying this combined treatment modality. These results should be validated within large cohort studies.
本研究旨在探讨白蛋白-胆红素（ALBI）评分在接受联合免疫检查点抑制剂（ICI）和放疗（RT）治疗不可切除肝细胞癌（HCC）患者中的预后价值。
回顾性纳入 2018 年 7 月至 2021 年 2 月期间接受联合 ICI 和 RT 治疗的不可切除 HCC 患者，并进行分析。采用 Cox 回归模型确定预后因素。采用 Kaplan-Meier 法进行生存分析。采用对数秩检验比较生存情况。
共纳入 38 例患者。中位随访时间为 16.5 个月（范围：6.7-29.9）。客观缓解率（ORR）为 28.9%，包括 3 例（7.9%）完全缓解。中位无进展生存期（PFS）为 5.6 个月（95%可信区间[CI]：3.2-8.0），中位总生存期（OS）为 12.9 个月（95%CI：8.3-17.6）。多因素 Cox 回归分析显示，ALBI 评分和年龄是 PFS 和 OS 的独立预后因素。ALBI 评分 1 级且年龄≥53 岁（低危组）的患者 ORR 更高（50.0% vs. 13.6%），中位 PFS（15.3 个月 vs. 2.7 个月）和 OS（未达到 vs. 10.1 个月）更长。15 例（39.5%）患者发生 3 级血液学毒性和/或肝功能异常；未中断治疗。未观察到 4 级或更高级别的不良反应。
联合 ICI 和 RT 是治疗不可切除 HCC 的一种有效方法，具有中等的副作用。在应用这种联合治疗方法时，ALBI 评分值得考虑。这些结果需要在大型队列研究中进一步验证。
