BACKGROUND Although the triple therapy of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitors and tyrosine kinase inhibitors is becoming an effective treatment for unresectable hepatocellul...BACKGROUND Although the triple therapy of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitors and tyrosine kinase inhibitors is becoming an effective treatment for unresectable hepatocellular carcinoma(uHCC).However,there is still a lack of effective tools for predicting therapeutic effects at present.AIM To develop a predictive tool for the prognosis of uHCC patients treated with TACE,sintilimab and lenvatinib.METHODS Based on multicenter data,this study constructed and validated an AADN score as variables to predict overall survival in patients treated with this combination therapy.This study included 188 uHCC cases(training cohort:n=101,validation cohort:n=87)from three different hospitals.Who were treated with TACE,sintilimab and lenvatinib.RESULTS In multivariate analysis,alpha-fetoprotein≥100 ng/mL[hazard ratio(HR)=2.579,P=0.010],alkaline phosphatase>120 U/L,(HR=2.234,P=0.021),direct bilirubin>7.3μmol/L(HR=2.931,P=0.007)and neutrophil to lymphocyte ratio>2.5(HR=3.127,P=0.006)were identified as independent prognostic factors and were used to establish the AADN score.Kaplan-Meier survival curves and time-dependent receiver operating characteristic curves were used to assess the accuracy of the AADN score,with area under receiver operating characteristic curve values of 0.827(training cohort,95%confidence interval:0.743-0.911)and 0.832(validation cohort,95%confidence interval:0.742-0.923).According to the score,the patients were divided into low-risk,intermediate-risk and highrisk groups.Overall survival and progression-free survival were significantly different between groups.CONCLUSION The AADN score can distinguish the prognostic risk of uHCC patients treated with TACE,sintilimab and lenvatinib,provides a basis for individualized treatment decision-making,and have clinical application prospect.展开更多
基金Supported by National Key Sci-Tech Special Project of China,No.2018ZX10302207Beijing Nova Program,No.20250484965+4 种基金Beijing Natural Science Foundation,No.7222191 and No.7244426Fundamental Research Funds for the Central Universities,Peking University,No.PKU2024XGK005Peking University Medicine Seed Fund for Interdisciplinary Research,No.BMU2021MX007 and No.BMU2022MX001Fundamental Research Funds for the Central Universities,Peking University People’s Hospital Scientific Research Development Funds,No.RDX2020-06 and No.RDJ2022-14the Qi-Min Project.
文摘BACKGROUND Although the triple therapy of transarterial chemoembolization(TACE)combined with immune checkpoint inhibitors and tyrosine kinase inhibitors is becoming an effective treatment for unresectable hepatocellular carcinoma(uHCC).However,there is still a lack of effective tools for predicting therapeutic effects at present.AIM To develop a predictive tool for the prognosis of uHCC patients treated with TACE,sintilimab and lenvatinib.METHODS Based on multicenter data,this study constructed and validated an AADN score as variables to predict overall survival in patients treated with this combination therapy.This study included 188 uHCC cases(training cohort:n=101,validation cohort:n=87)from three different hospitals.Who were treated with TACE,sintilimab and lenvatinib.RESULTS In multivariate analysis,alpha-fetoprotein≥100 ng/mL[hazard ratio(HR)=2.579,P=0.010],alkaline phosphatase>120 U/L,(HR=2.234,P=0.021),direct bilirubin>7.3μmol/L(HR=2.931,P=0.007)and neutrophil to lymphocyte ratio>2.5(HR=3.127,P=0.006)were identified as independent prognostic factors and were used to establish the AADN score.Kaplan-Meier survival curves and time-dependent receiver operating characteristic curves were used to assess the accuracy of the AADN score,with area under receiver operating characteristic curve values of 0.827(training cohort,95%confidence interval:0.743-0.911)and 0.832(validation cohort,95%confidence interval:0.742-0.923).According to the score,the patients were divided into low-risk,intermediate-risk and highrisk groups.Overall survival and progression-free survival were significantly different between groups.CONCLUSION The AADN score can distinguish the prognostic risk of uHCC patients treated with TACE,sintilimab and lenvatinib,provides a basis for individualized treatment decision-making,and have clinical application prospect.
