Prognostic Prediction and Risk Stratification of Transarterial Chemoembolization Combined with Targeted Therapy and
Wendi Kang1, Huafei Zhao2, Qicai Lian3
1Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China.
Purpose:
The combination of transarterial chemoembolization, molecular targeted therapy, and immunotherapy (triple therapy) has shown promising outcomes in the treatment of unresectable hepatocellular carcinoma (HCC). This study aimed to build a prognostic model to identify patients who could benefit from triple therapy.
Patients And Methods:
This retrospective study encompassed 242 patients with HCC who underwent triple therapy from two centers (Training cohort: 158 patients from the Center 1; External validation cohort: 84 patients from the Center 2). Independent predictors of overall survival (OS) and progression-free survival (PFS) were identified through Cox regression analyses, and prognostic models based on Cox proportional hazards models were developed. Prognosis was assessed using Kaplan - Meier curves.
Results:
In the training cohort, independent predictors of PFS included vascular invasion and the C-reactive protein and alpha-fetoprotein in immunotherapy (CRAFITY) score. Independent predictors of OS were the CRAFITY score, extrahepatic metastasis, and the neutrophil-to-lymphocyte ratio. Prognostic prediction models were constructed based on these variables. The prognostic model for OS demonstrated a C-index of 0.715 (95% confidence interval (CI), 0.662-0.768) in the training cohort and 0.701 (95% CI, 0.628-0.774) in the validation cohort. Patients were divided into low- and high-risk categories using the predictive model (P<0.001). These findings were corroborated by the external validation cohort.
Conclusion:
The developed prognostic model serves as a reliable and convenient tool to predict outcomes in patients with unresectable HCC undergoing triple therapy. It aids clinicians in making informed treatment decisions.
