European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Value of tumor burden score combined with alpha-fetoprotein stratification in transarterial chemoembolization plus tyrosine kinase inhibitors and immune checkpoint inhibitors as triple conversion therapy for patients with initially unresectable hepatocellular carcinoma: a multicenter retrospective study (GUIDANCE010).
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Li Zhi-Cheng, Li Cai-Hua, Yang Da-Long, Su Jia-Yong, Liu Shao-Ping, Ye Lin, Peng Ning, Zeng Fan-Jian, Li Mian-Jing, Liang Yong-Rong, Chen Shu-Chang, Yang Fu-Quan, Wang Xue-Yao, Qin Chuang, Zhong Teng-Meng, Mao Xian-Shuang, Su Ze, Dong Xiao-Feng, Yang Jin, Xu Bin, Su Hang, Han Ruo-Xin, Qin Zhen-Ling, Mo Bin-Yuan, Huang Hai-Ge, Zhong Jian-Hong, GUIDANCE investigators
Аннотация
BACKGROUND AND AIMS: Currently, transarterial chemoembolization plus tyrosine kinase inhibitors and immune checkpoint inhibitors (triple conversion therapy) has demonstrated remarkable efficacy in patients with unresectable hepatocellular carcinoma (uHCC). However, the optimal beneficiary population remains unclear. This study aims to combine the tumor burden score with alpha-fetoprotein to establish a novel scoring system (tumor burden-alpha-fetoprotein, TBA) and identify the optimal beneficiaries of this therapy.
METHODS: Data were collected from 359 patients with uHCC who received triple conversion therapy across 17 medical centers in China. Patients were stratified into low (n = 124), medium (n = 140), and high (n = 95) TBA groups, with subsequent prognostic comparisons performed among the three groups.
RESULTS: The higher TBA was associated with lower overall survival (OS) (medium vs. low: hazard ratio (HR) = 2.31, 95% confidence interval (CI): 1.30-4.12; high vs. medium: HR = 3.92, 95% CI: 2.17-7.09); the higher TBA was associated with lower progression-free survival (PFS) (medium vs. low: HR = 1.77, 95% CI: 1.23-2.56; high vs. medium: HR = 2.35, 95% CI: 1.59-3.49). TBA and underwent hepatectomy after triple conversion therapy were independent risk factors for OS (p = 0.048, p < 0.001); TBA and underwent hepatectomy after triple conversion therapy were independent risk factors for PFS (p = 0.008, p = 0.005). In the subgroup analysis of patients who didn't undergo hepatectomy, there were significant differences in OS and PFS among the different TBA groups, but not among those who underwent hepatectomy.
CONCLUSION: TBA is an independent prognostic factor for patients with initially uHCC who receiving triple conversion therapy. Stratification analysis based on this score may have important clinical value in predicting patients prognoses.
METHODS: Data were collected from 359 patients with uHCC who received triple conversion therapy across 17 medical centers in China. Patients were stratified into low (n = 124), medium (n = 140), and high (n = 95) TBA groups, with subsequent prognostic comparisons performed among the three groups.
RESULTS: The higher TBA was associated with lower overall survival (OS) (medium vs. low: hazard ratio (HR) = 2.31, 95% confidence interval (CI): 1.30-4.12; high vs. medium: HR = 3.92, 95% CI: 2.17-7.09); the higher TBA was associated with lower progression-free survival (PFS) (medium vs. low: HR = 1.77, 95% CI: 1.23-2.56; high vs. medium: HR = 2.35, 95% CI: 1.59-3.49). TBA and underwent hepatectomy after triple conversion therapy were independent risk factors for OS (p = 0.048, p < 0.001); TBA and underwent hepatectomy after triple conversion therapy were independent risk factors for PFS (p = 0.008, p = 0.005). In the subgroup analysis of patients who didn't undergo hepatectomy, there were significant differences in OS and PFS among the different TBA groups, but not among those who underwent hepatectomy.
CONCLUSION: TBA is an independent prognostic factor for patients with initially uHCC who receiving triple conversion therapy. Stratification analysis based on this score may have important clinical value in predicting patients prognoses.