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Early thyroid-stimulating hormone dynamics predict outcomes in advanced hepatocellular carcinoma treated with
Michinori Matsumoto1, Tomohiko Taniai2, Tadashi Uwagawa2
1Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan. mmatsumoto4@jikei.ac.jp.
Purpose:
Early predictive biomarkers for response to atezolizumab plus bevacizumab (Atez+Bev) in advanced hepatocellular carcinoma (HCC) remain unclear. We investigated the prognostic significance of early thyroid-stimulating hormone (TSH) dynamics and the aspartate aminotransferase-to-platelet ratio index (APRI) in patients receiving Atez+Bev.
Methods:
We retrospectively analyzed 32 patients with advanced HCC treated with Atez+Bev. TSH ratios after 1 and 2 treatment cycles were calculated relative to baseline. Cutoff values were determined using receiver operating characteristic analysis. Progression-free survival (PFS) was evaluated using Kaplan-Meier analysis and Cox proportional hazards models. Landmark analysis was performed to minimize immortal time bias.
Results:
The objective response rate was 25%. Patients with a low TSH ratio after 1 cycle (< 1.23) showed shorter PFS than those with a high ratio. In exploratory multivariable analysis, APRI ≥0.81 (hazard ratio [HR] 3.17, 95% confidence interval [CI] 1.02-9.81, p=0.046) and TSH ratio after 1 cycle <1.23 (HR 2.76, 95% CI 1.01-7.54, p=0.040) were independently associated with shorter PFS. Landmark analysis showed a consistent association between early TSH dynamics and PFS.
Conclusions:
Early TSH dynamics and baseline APRI may be useful for exploratory risk stratification in advanced HCC treated with Atez+Bev, although these findings require validation in larger cohorts.