联合CRAFITY评分和甲胎蛋白反应可预测接受基于抗程序性死亡-1阻断的免疫治疗的不可切除肝细胞癌患者的治疗结果。
Combined CRAFITY score and α-fetoprotein response predicts treatment outcomes in patients with unresectable hepatocellular carcinoma receiving anti-programmed death-1 blockade-based immunotherapy.
作者信息
Hsu Wei-Fan, Lai Hsueh-Chou, Chen Cheng-Kuo, Wang Hung-Wei, Chuang Po-Heng, Tsai Ming-Hung, Chen Sheng-Hung, Chu Chia-Sheng, Su Wen-Pang, Chou Jen-Wei, Kao Jung-Ta, Chen Hung-Yao, Chuang Shih-Chieh, Tsai Tsung-Yu, Hsiao Wang-De, Huang Guan-Tarn, Peng Cheng-Yuan
机构信息
Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital Taichung, Taiwan.
Graduate Institute of Biomedical Science, China Medical University Taichung, Taiwan.
出版信息
Am J Cancer Res. 2023 Feb 15;13(2):654-668. eCollection 2023.
Biomarkers for predicting the treatment efficacy of immune checkpoint inhibitor (ICI)-based therapy in patients with unresectable hepatocellular carcinoma (uHCC) are crucial. Previous studies demonstrated that C-reactive protein and alpha-fetoprotein (AFP) in immunotherapy (CRAFITY) score at baseline predicted treatment outcomes and that patients with uHCC with AFP response, defined as > 15% decline in AFP level within the initial 3 months of ICI-based therapy, had favorable outcomes when receiving ICI-based therapy. However, whether the combination of CRAFITY score and AFP response could be used to predict treatment efficacy of programmed death-1 (PD-1) blockade-based therapy in uHCC patients remains unclear. We retrospectively enrolled 110 consecutive uHCC patients from May 2017 to March 2022. The median ICI treatment duration was 2.85 (1.67-6.63) months, and 87 patients received combination therapies. The objective response and disease control rates were 21.8% and 46.4%, respectively. The duration of progression-free survival (PFS) and overall survival (OS) was 2.87 (2.16-3.58) months and 8.20 (4.23-12.17) months, respectively. We categorized patients into three groups based on CRAFITY score (2 vs 0/1) and AFP response: patients with a CRAFITY score of 0/1 and AFP response (Group 1), those with a CRAFITY score of 2 and no AFP response (group 3), and those who did not belong to Group 1 and 3 (i.e., Group 2). The combination of CRAFITY score and AFP response could predict disease control and could predict PFS compared with CRAFITY score or AFP response alone. The combination of CRAFITY score and AFP response was an independent predictor of OS (Group 2 vs Group 1, HR: 4.513, 95% CI 1.990-10.234; Group 3 vs Group 1, HR: 3.551, 95% CI 1.544-8.168). Our findings indicated that the combination of CRAFITY score and AFP response could predict disease control, PFS, and OS in uHCC patients receiving PD-1 blockade-based immunotherapy.
生物标志物对于预测不可切除肝细胞癌（uHCC）患者基于免疫检查点抑制剂（ICI）治疗的疗效至关重要。既往研究表明，基线时免疫治疗（CRAFITY）评分中的C反应蛋白和甲胎蛋白（AFP）可预测治疗结果，且uHCC患者若出现AFP反应（定义为在基于ICI治疗的最初3个月内AFP水平下降>15%），接受基于ICI治疗时预后良好。然而，CRAFITY评分与AFP反应的联合是否可用于预测uHCC患者基于程序性死亡-1（PD-1）阻断治疗的疗效仍不清楚。我们回顾性纳入了2017年5月至2022年3月期间连续的110例uHCC患者。ICI治疗的中位持续时间为2.85（1.67 - 6.63）个月，87例患者接受了联合治疗。客观缓解率和疾病控制率分别为21.8%和46.4%。无进展生存期（PFS）和总生存期（OS）分别为2.87（2.16 - 3.58）个月和8.20（4.23 - 12.17）个月。我们根据CRAFITY评分（2 vs 0/1）和AFP反应将患者分为三组：CRAFITY评分为0/1且有AFP反应的患者（第1组）、CRAFITY评分为2且无AFP反应的患者（第3组）以及不属于第1组和第3组的患者（即第2组）。与单独的CRAFITY评分或AFP反应相比，CRAFITY评分与AFP反应的联合可预测疾病控制情况，也可预测PFS。CRAFITY评分与AFP反应的联合是OS的独立预测因素（第2组vs第1组，HR：4.513，95%CI 1.990 - 10.234；第3组vs第1组，HR：3.551，95%CI 1.544 - 8.168）。我们的研究结果表明，CRAFITY评分与AFP反应的联合可预测接受基于PD-1阻断免疫治疗的uHCC患者的疾病控制情况、PFS和OS。
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