Personalized prognosis in unresectable hepatocellular carcinoma: Development and validation of a model for transcatheter arterial chemoembolization plus lenvatinib.

BACKGROUND

Transcatheter arterial chemoembolization (TACE) combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma (HCC). To date, no prognostic analysis exists for clinical predictive models of TACE combined with lenvatinib in treating advanced unresectable HCC. A model was constructed through meta-analysis, and its validation was further enhanced by the collection of external clinical data, thereby providing guidance for clinical practice.

AIM: To identify risk factors for unresectable HCC following TACE plus lenvatinib therapy and to construct a clinical prediction model.

METHODS

We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases for studies on TACE plus lenvatinib for unresectable HCC. Risk factors from the meta-analysis and sensitivity analyses were used to construct a prediction model. The validation set included clinical data from 106 eligible patients at the Affiliated Hospital of North Sichuan Medical College collected by June 1, 2023.

RESULTS

This study included 43 group studies involving 5070 patients. Tumor number, microvascular invasion, Eastern Cooperative Oncology Group performance status, Child-Pugh stage, Barcelona Clinic Liver Cancer stage, extrahepatic metastases, alpha-fetoprotein level, and hepatitis B virus status were risk factors for overall survival and progression-free survival, while triple therapy was a protective factor for both. In the validation set, the overall survival prediction model had area under the curve values of 0.616, 0.643, and 0.706 at 1 year, 2 years, and 3 years, respectively, and the progression-free survival model had area under the curve values of 0.702, 0.696, and 0.670 at the corresponding time points, demonstrating good model performance. Calibration curves, Kaplan-Meier survival analysis, and decision curves further validated the efficacy of the model.

CONCLUSION

Models based on nine variables from 43 group studies predicted the efficacy of TACE plus lenvatinib in unresectable HCC, supporting evidence-based clinical decisions and treatment strategies.