预测不可切除肝细胞癌免疫治疗联合局部区域治疗预后的AFCRPLITY评分。
The AFCRPLITY score for predicting the prognosis of immunotherapy combined with local-regional therapy in unresectable hepatocellular carcinoma.
作者信息
Zuo Mengxuan, Wei Ran, Li Da, Li Wang, An Chao
机构信息
Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
State Key Laboratory of Oncology in South China, Guangzhou, P.R. China.
出版信息
Ther Adv Med Oncol. 2024 Nov 19;16:17588359241297080. doi: 10.1177/17588359241297080. eCollection 2024.
BACKGROUND
Immunotherapy combined with intra-arterial therapy (IAT) has shown great potential in the treatment of unresectable hepatocellular carcinoma (uHCC). However, there are currently no available biomarkers that can predict the prognosis of immune-based combined therapy.
OBJECTIVES
To establish a scoring method to predict prognosis in uHCC patients undergoing IAT plus immunotherapy.
METHODS
Between March 2019 and August 2022, uHCC patients undergoing IAT in combination with programmed cell death (ligand) 1 (PD-1)/PD-L1-based immunotherapy were retrospectively analyzed.
RESULTS
Among 1046 patients included, 780 patients were enrolled into hepatic arterial infusion chemotherapy immunotherapy cohorts (training set: = 546, one center; external testing set: = 234, three centers) and 266 patients were treated with trans-arterial chemoembolization (TACE) plus immunotherapy were enrolled into TACE immunotherapy cohort (validation set: = 266). We developed the easy-to-apply alpha-fetoprotein (AFP), C-reactive protein (CRP), and platelet-to-lymphocyte ratio (PLR) in immunotherapy (AFCRPLITY) score and investigated the prognostic value of baseline variables on the disease control rate (DCR) and progression-free survival (PFS). HCC patients with low AFCRPLITY scores would have better PFS and DCRs than patients with high AFCRPLITY scores (AFCRPLITY 0: vs AFCRPLITY 1: vs AFCRPLITY 2: vs AFCRPLITY 3: < 0.001 for PFS, = 0.001 for DCRs) in the training set, which was confirmed in the external testing set and validation set. The highest level of CD8+ T cells was in the AFCRPLITY score = 0 group than the other two groups.
CONCLUSION
The AFCRPLITY score is associated with PFS and DCR in uHCC patients receiving IATs plus immunotherapy. This score may be helpful for counseling, but prospective validation is needed.
DESIGN
A retrospective, multi-institutional study.
TRIAL REGISTRATION
The study has been retrospectively registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR2300075828).
背景
免疫疗法联合动脉内治疗（IAT）在不可切除肝细胞癌（uHCC）的治疗中显示出巨大潜力。然而，目前尚无可用的生物标志物能够预测基于免疫的联合治疗的预后。
目的
建立一种评分方法，以预测接受IAT加免疫疗法的uHCC患者的预后。
方法
回顾性分析2019年3月至2022年8月期间接受IAT联合程序性细胞死亡（配体）1（PD-1）/PD-L1免疫疗法的uHCC患者。
结果
在纳入的1046例患者中，780例患者被纳入肝动脉灌注化疗免疫治疗队列（训练集：=546例，一个中心；外部测试集：=234例，三个中心），266例接受经动脉化疗栓塞（TACE）加免疫治疗的患者被纳入TACE免疫治疗队列（验证集：=266例）。我们开发了易于应用的免疫治疗中甲胎蛋白（AFP）、C反应蛋白（CRP）和血小板与淋巴细胞比值（PLR）（AFCRPLITY）评分，并研究了基线变量对疾病控制率（DCR）和无进展生存期（PFS）的预后价值。在训练集中，AFCRPLITY评分低的HCC患者的PFS和DCR优于AFCRPLITY评分高的患者（AFCRPLITY 0：与AFCRPLITY 1：与AFCRPLITY 2：与AFCRPLITY 3：PFS<0.001，DCR=0.001），这在外部测试集和验证集中得到证实。AFCRPLITY评分为0的组中CD8+T细胞水平高于其他两组。
结论
AFCRPLITY评分与接受IAT加免疫疗法的uHCC患者的PFS和DCR相关。该评分可能有助于提供咨询，但需要进行前瞻性验证。
设计
一项回顾性、多机构研究。
试验注册
该研究已在中国临床试验注册中心（https://www.chictr.org.cn/，ChiCTR2300075828）进行回顾性注册。
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