New prognostic system based on inflammation and liver function predicts prognosis in patients with advanced unresectable hepatocellular carcinoma treated with atezolizumab plus bevacizumab: A validation study
Toshifumi Tada, Takashi Kumada, Atsushi Hiraoka, Kazuya Kariyama, Joji Tani, Masashi Hirooka, Koichi Takaguchi, Masanori Atsukawa, Shinya Fukunishi, Ei Itobayashi, Kunihiko Tsuji, Kazuto Tajiri, Hironori Ochi, Toru Ishikawa, Satoshi Yasuda, Chikara Ogawa, Hidenori Toyoda, Takeshi Hatanaka, Takashi Nishimura, Satoru Kakizaki, Kazuhito Kawata, Noritomo Shimada, Fujimasa Tada, Kazuhiro Nouso, Akemi Tsutsui, Hideko Ohama, Asahiro Morishita, Takuya Nagano, Norio Itokawa, Tomomi Okubo, Taeang Arai, Hisashi Kosaka, Michitaka Imai, Atsushi Naganuma, Shinichiro Nakamura, Yohei Koizumi, Masaki Kaibori, Hiroko Iijima, Yoichi Hiasa
Abstract
AIM: Recently, the neo-Glasgow prognostic score (GPS), a composite biomarker determined by the C-reactive protein level and albumin-bilirubin grade, was developed to predict outcomes in hepatocellular carcinoma (HCC) patients who undergo hepatic resection. The present research investigated whether the neo-GPS could predict prognosis in HCC patients treated with atezolizumab plus bevacizumab (Atez/Bev). METHODS: A total of 421 patients with HCC who were treated with Atez/Bev were investigated. RESULTS: Multivariate Cox hazards analysis showed that a GPS of 1 (hazard ratio (HR), 1.711; 95% confidence interval (CI), 1.106-2.646) and a GPS of 2 (HR, 4.643; 95% CI, 2.778-7.762) were independently associated with overall survival. Conversely, multivariate Cox hazards analysis showed that a neo-GPS of 1 (HR, 3.038; 95% CI, 1.715-5.383) and a neo-GPS of 2 (HR, 5.312; 95% CI, 2.853-9.890) were also independently associated with overall survival in this cohort. Additionally, cumulative overall survival rates differed significantly by GPS and neo-GPS (p < 0.001). The neo-GPS, compared with the GPS, had a lower Akaike information criterion (1207 vs. 1,211, respectively) and a higher c-index (0.677 vs. 0.652, respectively) regarding to overall survival. In a subgroup analysis of patients considered to have a good prognosis as confirmed using a Child-Pugh score of 5 (p = 0.001), a neutrophil-to-lymphocyte ratio <3 (p = 0.001), or an α-fetoprotein level < 100 ng/mL (p < 0.001), those with a high neo-GPS (≥1) had a statistically poorer overall survival than those with a low neo-GPS. CONCLUSIONS: The neo-GPS can predict prognosis in advanced unresectable HCC patients treated with Atez/Bev.