Department of Minimally Invasive Intervention, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
Department of Radiology, Guangdong Provincial Key Laboratory of Major Obstetric Discases; Guangdong Provincial Clinical Research Center for 0bstetricsc and Gynecology;The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Immunother Cancer. 2024 Jan 30;12(1):e008191. doi: 10.1136/jitc-2023-008191.
Dual programmed death 1 (PD-1) and angiogenesis blockade therapy is a frontline treatment for hepatocellular carcinoma (HCC). An accepted model for survival prediction and risk stratification in individual patients receiving this treatment is lacking. Aimed to develop a simple prognostic model specific to these patients.
Patients with unresectable HCC undergoing dual PD-1 and angiogenesis blockade therapy were included in training cohort (n=168) and validation cohort (n=72). We investigated the prognostic value of clinical variables on overall survival using a Cox model in the training set. A prognostic score model was then developed and validated. Predictive performance and discrimination were also evaluated. argest tumor size and lpha-fetoprotein concentration at baseline and eutrophil count and pleen volume change after 6 weeks of treatment were identified as independent predictors of overall survival in multivariable analysis and used to develop LANS score. Time-dependent receiver operating characteristic analysis, calibration curves, and C-index showed LANS score had favorable performance in survival prediction. Patients were divided into three risk categories based on LANS score. Median survival for patients with low, intermediate, and high LANS scores was 31.7, 23.5, and 11.5 months, respectively (p<0.0001). The disease control rates were 96.4%, 64.3%, and 32.1%, respectively (p<0.0001). The predictive performance and risk stratification ability of the LANS score were confirmed in validation and entire cohorts.
The LANS score model can provide individualized survival prediction and risk stratification in patients with unresectable HCC undergoing dual PD-1 and angiogenesis blockade therapy.
双重程序性死亡受体 1（PD-1）和血管生成阻断治疗是肝细胞癌（HCC）的一线治疗方法。对于接受这种治疗的个体患者，缺乏一种公认的生存预测和风险分层模型。本研究旨在为这些患者建立一种简单的预后模型。
纳入了接受双重 PD-1 和血管生成阻断治疗的不可切除 HCC 患者作为训练队列（n=168）和验证队列（n=72）。我们在训练集中使用 Cox 模型研究了临床变量对总生存期的预后价值。然后建立并验证了预后评分模型。还评估了预测性能和区分度。最大肿瘤大小和基线时的α-胎蛋白浓度、治疗 6 周后中性粒细胞计数和脾脏体积变化被确定为多变量分析中总生存期的独立预测因子，并用于开发 LANS 评分。时间依赖性接受者操作特征分析、校准曲线和 C 指数表明，LANS 评分在生存预测中具有良好的性能。根据 LANS 评分将患者分为三个风险类别。低、中、高 LANS 评分患者的中位生存期分别为 31.7、23.5 和 11.5 个月（p<0.0001）。相应的疾病控制率分别为 96.4%、64.3%和 32.1%（p<0.0001）。在验证队列和整个队列中均证实了 LANS 评分的预测性能和风险分层能力。
LANS 评分模型可为接受双重 PD-1 和血管生成阻断治疗的不可切除 HCC 患者提供个体化的生存预测和风险分层。
