AADN score: Predicting response to transarterial chemoembolization, sintilimab and lenvatinib in patients with hepatocellular carcinoma.

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 > 7.3 μmol/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 high-risk 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.