Teng Wei, Cheng Tai-An, Lin Po-Ting, Lin Chen-Chun, Lin Chun-Yen, Lin Shi-Ming
Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
Am J Cancer Res. 2023 Jun 15;13(6):2702-2713. eCollection 2023.
Regorafenib improved prognosis for unresectable hepatocellular carcinoma (uHCC) after sorafenib treatment failure. We aimed to investigate prognostic value of combining systemic inflammatory markers with liver function evaluation in patients receiving sorafenib-regorafenib sequential therapy. A total of 122 uHCC patients who received sorafenib-regorafenib sequential therapy were retrospectively enrolled for analysis. The pre-treatment preserving liver function and six inflammatory indexes were collected. The Cox regression model was used to identify independent predictors of progression-free survival (PFS) and overall survival (OS). Baseline ALBI grade I (hazard ratio (HR) = 0.725, P = 0.040 for PFS; HR = 0.382, P = 0.012 for OS) and systemic inflammatory index (SII) ≤ 330 (HR = 0.341, P = 0.017 for OS; HR = 0.485, P = 0.037 for OS) were identified as independent prognostic factors in multivariable analysis and were used to develop the scoring system. Patients who fulfilled both criteria (2 points; score-high) had the longest median PFS (not-reached) and OS (not-reached), followed by fulfilling 1 criterion (1 point; score-intermediate; PFS: 3.7 months and OS: 17.9 months), and patients fulfilled no criterion (0 point; score-low; PFS: 2.9 months, overall log-rank P = 0.001 and OS: 7.5 months, overall log-rank P = 0.003). Additionally, best radiological response was significantly higher in patients with score-high (complete response/partial response/stable disease/progressive disease: score-high: 5.9%/5.9%/58.8%/29.4% vs. score-intermediate: 0%/14.0%/44.2%/41.9% vs. score-low: 0%/0%/25.0%/75.0%; P = 0.011). In conclusion, a combination of baseline ALBI grade and SII index can be used as a simple and powerful parameter to predict prognosis of uHCC patients receiving regorafenib after sorafenib-refractory treatment. The score may help with patient counseling but requires prospective validation.
瑞戈非尼改善了索拉非尼治疗失败后不可切除肝细胞癌（uHCC）的预后。我们旨在研究在接受索拉非尼-瑞戈非尼序贯治疗的患者中，将全身炎症标志物与肝功能评估相结合的预后价值。回顾性纳入了122例接受索拉非尼-瑞戈非尼序贯治疗的uHCC患者进行分析。收集治疗前的肝功能指标和六项炎症指标。采用Cox回归模型确定无进展生存期（PFS）和总生存期（OS）的独立预测因素。多变量分析确定基线ALBI I级（PFS的风险比（HR）=0.725，P = 0.040；OS的HR = 0.382，P = 0.012）和全身炎症指数（SII）≤330（OS的HR = 0.341，P = 0.017；OS的HR = 0.485，P = 0.037）为独立预后因素，并用于建立评分系统。符合两项标准的患者（2分；高分）的中位PFS（未达到）和OS（未达到）最长，其次是符合一项标准的患者（1分；中等分；PFS：3.7个月，OS：17.9个月），不符合任何标准的患者（0分；低分；PFS：2.9个月，总体对数秩检验P = 0.001，OS：7.5个月，总体对数秩检验P = 0.003）。此外，高分患者的最佳影像学缓解率显著更高（完全缓解/部分缓解/疾病稳定/疾病进展：高分：5.9%/5.9%/58.8%/29.4% vs. 中等分：0%/14.0%/44.2%/41.9% vs. 低分：0%/0%/25.0%/75.0%；P = 0.011）。总之，基线ALBI分级和SII指数的组合可作为预测索拉非尼难治性治疗后接受瑞戈非尼治疗的uHCC患者预后的简单且有力的参数。该评分可能有助于患者咨询，但需要前瞻性验证。
