Prediction of treatment response and survival in patients with advanced hepatocellular carcinoma receiving sorafenib: pretreatment prognostic scores.

INTRODUCTION

Sorafenib is currently among the recommended first-line medications for patients with advanced hepatocellular carcinoma (HCC); however, response to sorafenib remains unpredictable despite efforts to define prognosis. This study aims to predict treatment response and survival in patients with sorafenib-treated HCC using neutrophil-to-lymphocyte ratio (NLR), albumin-bilirubin (ALBI) grade, CRAFITY score, and Glasgow prognostic score (GPS).

METHODS

This prospective study recruited 75 Egyptian patients with Sorafenib-treated HCC. Pretreatment laboratory parameters and imaging studies were obtained. The neutrophil-to-lymphocyte ratio, ALBI grade, CRAFITY score, and GPS were calculated for each patient. All the patients were followed for treatment response, overall survival, and sorafenib tolerance.

RESULTS

Most of the participants were males, with a median age of 62 years. HCV was the most common underlying cause. Most of the patients had a low pretreatment NLR (77.33%), grade 2 ALBI (65.33%), 41.89% had a high CRAFITY score, and 48.6% had GPS 1. Patients were divided into two groups: group 1: sorafenib-naïve (n = 44) and group 2: patients with previous interventional therapy (n = 31). Pretreatment AST, ALT, mild ascites, portal invasion, and BCLC stage C were significantly higher among sorafenib-naïve patients. Median OS and time to progression for the entire cohort were 4 months and 9 months, respectively. No significant differences were observed in terms of OS between various NLR, ALBI grades, CRAFITY scores, and GPS. Multivariate analysis showed a high risk of mortality among sorafenib-intolerant patients (p = 0.01, HR: 2.33, 95% CI: 1.23-4.42).

CONCLUSION

Overall survival and time to progression are not affected by different pretreatment values of NLR, ALBI grade, CRAFITY score, and Glasgow prognostic score in sorafenib-treated HCC.