肿瘤负荷评分和甲胎蛋白水平可预测接受酪氨酸激酶抑制剂和抗程序性死亡蛋白1抗体治疗的不可切除肝细胞癌患者的预后。
Tumor burden score and alpha-fetoprotein level predict prognosis of patients with unresectable hepatocellular carcinoma treated with tyrosine kinase inhibitor and anti-PD-1 antibody.
作者信息
Tang Shichuan, Huang Tingfeng, Luo Cong, Fu Jun, Zhang Kailing, Chen Qingjing, Kong Jie, Zhang Jianxi, Sun Zhenghong, Diao Yongkang, Lin Kongying, Zeng Yongyi
机构信息
Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China.
Department of Hepatopancreatobiliary Surgery, Wanyuan Central Hospital, Wanyuan 636350, China.
出版信息
ILIVER. 2024 Aug 8;3(3):100109. doi: 10.1016/j.iliver.2024.100109. eCollection 2024 Sep.
BACKGROUND
Tyrosine kinase inhibitors (TKIs) and anti-PD-1 antibodies in combination provide survival benefits for patients with unresectable hepatocellular carcinoma (uHCC). However, the tool used to determine which patients likely benefit most from this treatment strategy has not been reported. We sought to develop a prognostic scoring system based on tumor burden score (TBS) and alpha-fetoprotein (AFP) to predict the long-term prognosis of uHCC treated with TKIs and anti-PD-1 antibodies.
METHODS
Data on patients with uHCC treated with TKIs and anti-PD-1 antibodies from multiple centers were collected. The prognostic accuracy of TBS, AFP, Barcelona Clinic Liver Cancer (BCLC), and CTA (Combined TBS and AFP) for 2-year progression-free survival (PFS) and overall survival (OS) was evaluated.
RESULTS
Overall, 278 patients with uHCC treated with TKIs and anti-PD-1 antibodies were enrolled, including 48 BCLC-B and 230 BCLC-C HCC patients. CTA (AUC = 0.721 and 0.683) outperformed TBS (AUC = 0.680 and 0.621), AFP (AUC = 0.606 and 0.594), and BCLC staging (AUC = 0.551 and 0.555) in predicting PFS and OS. The 2-year PFS and OS for low CTA (low TBS/low AFP) were 65.7% and 94.4%, respectively, which were significantly higher than 21.6% and 44.9% ( < 0.001 and = 0.002), respectively, for intermediate CTA (low TBS/high AFP or high TBS/low AFP) and 8.7% and 12.1% (both < 0.001), respectively, for high CTA (high TBS/high AFP). Multivariable Cox regression analysis indicated that CTA grading was an independent prognostic factor for PFS and OS (referent: low CTA; intermediate CTA, HR 2.87 and 7.17; high CTA, HR 5.52 and 10.31, respectively).
CONCLUSIONS
CTA grading is an accurate tool for stratifying the prognosis of uHCC treated with TKIs and anti-PD-1 antibodies and may help determine which patients may benefit more from this treatment strategy.
背景
酪氨酸激酶抑制剂（TKIs）与抗程序性死亡蛋白1（PD-1）抗体联合使用可为不可切除肝细胞癌（uHCC）患者带来生存获益。然而，尚未有报道称有工具可用于确定哪些患者可能从该治疗策略中获益最多。我们试图开发一种基于肿瘤负荷评分（TBS）和甲胎蛋白（AFP）的预后评分系统，以预测接受TKIs和抗PD-1抗体治疗的uHCC患者的长期预后。
方法
收集了多个中心接受TKIs和抗PD-1抗体治疗的uHCC患者的数据。评估了TBS、AFP、巴塞罗那临床肝癌（BCLC）分期和CTA（联合TBS和AFP）对2年无进展生存期（PFS）和总生存期（OS）的预后准确性。
结果
总体而言，纳入了278例接受TKIs和抗PD-1抗体治疗的uHCC患者，其中包括48例BCLC-B期和230例BCLC-C期肝癌患者。在预测PFS和OS方面，CTA（曲线下面积[AUC]=0.721和0.683）优于TBS（AUC=0.680和0.621）、AFP（AUC=0.606和0.594）以及BCLC分期（AUC=0.551和0.555）。低CTA（低TBS/低AFP）组的2年PFS和OS分别为65.7%和94.4%，显著高于中CTA（低TBS/高AFP或高TBS/低AFP）组的21.6%和44.9%（分别P<0.001和P=0.002），以及高CTA（高TBS/高AFP）组的8.7%和12.1%（均P<0.001）。多变量Cox回归分析表明，CTA分级是PFS和OS的独立预后因素（参照：低CTA；中CTA，风险比[HR]分别为2.87和7.17；高CTA，HR分别为5.52和10.31）。
结论
CTA分级是对接受TKIs和抗PD-1抗体治疗的uHCC患者进行预后分层的准确工具，可能有助于确定哪些患者可能从该治疗策略中获益更多。
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