Predicting Decompensation in Unresectable Hepatocellular Carcinoma on Atezolizumab Plus Bevacizumab: The ARTE Score.
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Canova Lorenzo, Alimenti Eleonora, Argiento Lorenzo, Cabibbo Giuseppe, Tovoli Francesco, Di Giacomo Emanuela, Galle Peter R, Celsa Ciro, Pinter Matthias, Marron Thomas U, Vivaldi Caterina, Dalbeni Andrea, Marra Fabio, Palloni Andrea, Lonardi Sara, Ponziani Francesca Romana, Federico Piera, Saeed Anwaar, Pillai Anjana, Pressiani Tiziana, Camera Silvia, Svegliati-Baroni Gianluca, Manfredi Giulia Francesca, Lani Lorenzo, von Felden Johann, Ulahannan Susanna, Ielasi Luca, De Lorenzo Stefania, Mazzarelli Chiara, Sacco Rodolfo, Rohlen Natascha, Silletta Marianna, Toniutto Pierluigi, Ascari Sara, Fulgenzi Claudia, Scheiner Bernhard, Crowley Fionnuala, Cerini Federica, Lampertico Pietro, Pinato David James, Iavarone Massimo
Аннотация
METHODS: This study enrolled 453 patients from the Atezolizumab-Bevacizumab Real-Life Experience for Treatment of Hepatocellular Carcinoma database (atezolizumab plus bevacizumab first-line, Child-Pugh A). External validation cohort included 292 patients from the atezolizumab plus bevacizumab-real database. Independent predictors derived from Cox regression were combined into a weighted score and operationalized as a point-based algorithm. Patients were then stratified into low-, intermediate-, and high-risk groups.
RESULTS: In the Atezolizumab-Bevacizumab Real-Life Experience for Treatment of Hepatocellular Carcinoma (ARTE) database, 74 (16.3%) patients developed hepatic decompensation (median follow-up, 14 months). Neoplastic portal vein thrombosis (hazard ratio, 1.97; 95% confidence interval, 1.20-3.23; P = .007), elevated bilirubin (hazard ratio, 2.61; 95% confidence interval, 1.52-4.47; P < .001), and low platelets (hazard ratio, 1.82; 95% confidence interval, 1.07-3.10; P = .026) were independent predictors, and they were incorporated into the ARTE score. Patients were categorized as low- (0-1 points; n = 360), intermediate- (2 points; n = 49), or high-risk (3-4 points; n = 44). Intermediate-risk patients had a 1.96-fold decompensation risk (P = .038), and high-risk patients a 4.28-fold risk (P < .001), compared with low-risk patients. Significant separation of decompensation-free survival across groups was observed (P < .001), with good discrimination (Harrell's C = 0.7022). Decompensation-free survival at 12 and 24 months was 87% and 83% for low-risk, 79% and 64% for intermediate-risk, and 57% and 56% for high-risk patients, respectively. The ARTE score retained prognostic value in the atezolizumab plus bevacizumab-real cohort (hazard ratio, 1.78; P = .009).
CONCLUSIONS: The ARTE score is an easy-to-use tool to predict hepatic decompensation in unresectable hepatocellular carcinoma, aiding clinical decision-making.