Prognostic Value of the SEA Score in Double-Negative DCP/AFP Unresectable HCC with Triple Therapy
Hesheng Lin1, Fulin Ran2, Jiayi Wu3
1Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People's Republic of China.
Background & Aims:
The combination of transarterial chemoembolization (TACE), lenvatinib and PD-1 inhibitors (triple therapy) demonstrates encouraging efficacy in patients with unresectable hepatocellular carcinoma (uHCC). But its prognostic value remains unclear in patients with double negative des gamma carboxy prothrombin (DCP) and alpha fetoprotein (AFP) uHCC. To identify the best candidates for this treatment, this study aimed to evaluate the prognosis of this specific population and to establish a practical prognostic scoring model.
Methods:
This multicenter retrospective study included 136 patients with double-negative DCP/AFP uHCC receiving triple therapy, stratified into training (n=91) and validation (n=45) cohorts. Independent predictors for overall survival (OS) were identified by Cox regression to build a scoring system. The model's performance was validated using Kaplan-Meier curves and the area under the receiver operating characteristic curve (AUC).
Results:
In the training cohort, median OS was not reached, and median progression-free survival was 18.9 months. Additionally, triple therapy produced a 79.1% objective response rate and a 95.6% disease control rate. Four variables (maximal tumor size ≥ 5 cm, absence of conversion surgery, presence of extrahepatic metastasis, and age < 55 years), were independent risk factors for prognosis and were utilized to develop the SEA score. The SEA score effectively stratified patients into low risk (0-3 points) and high risk (4-6 points) groups, with significantly different survival outcomes in both cohorts. This model showed robust discriminative performance, with AUCs of 0.80 in the training cohort and 0.68 in the validation cohort, and outperformed all individual prognostic factors.
Conclusion:
Triple therapy demonstrates promising efficacy and an acceptable safety profile in patients with double-negative DCP/AFP uHCC. The SEA score effectively stratifies patient outcomes, facilitating the identification of optimal candidates for triple therapy, though prospective validation is warranted before widespread clinical use.