GRAPHS-CRAFITY 评分：一种新型疗效预测工具，用于治疗不可切除的肝细胞癌的免疫治疗。

The GRAPHS-CRAFITY score: a novel efficacy predictive tool for unresectable hepatocellular carcinoma treated with immunotherapy.

机构信息

Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Radiol Med. 2024 Feb;129(2):188-201. doi: 10.1007/s11547-023-01753-z. Epub 2024 Jan 5.

DOI:10.1007/s11547-023-01753-z

PMID:38180570

Abstract

OBJECTIVES

To investigate MR features associated with prognosis of unresectable HCC receiving immunotherapy and establish a MR feature-based scoring system to predict efficacy of immunotherapy.

METHODS

This retrospective study included patients with unresectable HCC who received immunotherapy at 2 hospitals between August 2018 and February 2022. The last follow-up was October 2022. Clinical variables and MR features were assessed using univariate and multivariate Cox regression analyses. A new scoring system was constructed based on independent risk factors and the CRAFITY score consisting of AFP (≥ 100 ng/ml) and CRP (≥ 1 mg/dl). And the predictive performance of CRAFITY core and new score were compared by receiver-operating-characteristics curves (ROCs), area under ROCs (AUCs), and calibration curves.

RESULTS

A total of 166 patients (55.6 ± 10.4 years) were included in training cohort and 77 patients (55.4 ± 10.7 years) were included in validation cohort. There were significant differences in BCLC stage, max size, macrovascular invasion, intratumoral artery, and enhancing capsule between the 2 groups. Based on independent risk factors (gross GRowtH type, intratumoral fAt, enhancing tumor caPsule, Sex and CRAFITY score), a novel efficacy predictive tool named the GRAPHS-CRAFITY score was developed to predict OS. The OS was significantly different among the 3 groups according to GRAPHS-CRAFITY score (p value < 0.001). The GRAPHS-CRAFITY score could predict tumor response and disease control (p value < 0.001, p value < 0.001).

CONCLUSIONS

The GRAPHS-CRAFITY score is a reliable and easily applicable tool to predict the efficacy of unresectable HCC receiving immunotherapy.

摘要

目的

探讨与接受免疫治疗的不可切除 HCC 预后相关的 MR 特征，并建立一种基于 MR 特征的评分系统，以预测免疫治疗的疗效。

方法

本回顾性研究纳入了 2018 年 8 月至 2022 年 2 月期间在 2 家医院接受免疫治疗的不可切除 HCC 患者。最后一次随访时间为 2022 年 10 月。使用单变量和多变量 Cox 回归分析评估临床变量和 MR 特征。根据独立风险因素和包括 AFP（≥100ng/ml）和 CRP（≥1mg/dl）在内的 CRAFITY 评分，构建了一个新的评分系统。通过受试者工作特征曲线（ROC）、ROC 下面积（AUC）和校准曲线比较 CRAFITY 核心和新评分的预测性能。

结果

共纳入 166 例患者（55.6±10.4 岁）作为训练队列，77 例患者（55.4±10.7 岁）作为验证队列。两组间 BCLC 分期、最大直径、大血管侵犯、肿瘤内动脉和增强包膜存在显著差异。基于独立风险因素（大体生长类型、肿瘤内脂肪、增强肿瘤包膜、性别和 CRAFITY 评分），开发了一种新的疗效预测工具，命名为 GRAPHS-CRAFITY 评分，用于预测 OS。根据 GRAPHS-CRAFITY 评分，三组之间的 OS 差异有统计学意义（p 值<0.001）。GRAPHS-CRAFITY 评分可以预测肿瘤反应和疾病控制（p 值<0.001，p 值<0.001）。