A Nomogram-Based Prognostic Model for Advanced Hepatocellular Carcinoma Patients Treated with Sorafenib: A Multicenter Study

Abstract

Among scores and staging systems used for HCC, none showed a good prognostic ability in patients with advanced HCC treated with Sorafenib. We aimed to evaluate predictive factors of overall survival (OS) and drug response in HCC patients undergoing Sorafenib included in the Italian Liver Cancer (ITA.LI.CA.) multicenter cohort. Patients in the ITA.LI.CA database treated with Sorafenib and updated on 30 June 2019 were included. Demographic and clinical data before starting Sorafenib treatment were considered. For the evaluation of predictive factors for OS, a time-dependent Cox proportional hazard model was used. A total of 1107 patients were included in our analysis. The mean age was 64.3 years and 81.7% were male. Most patients were staged as BCLC B (205, 18.9%) or C (706, 65.1%). The median time of Sorafenib administration was 4 months (interquartile range (IQR) 2–12), and the median OS was 10 months (IQR: 4–20). A total of 263 patients (33.8%) out of 780 with available evaluation experienced objective tumoral response to Sorafenib. The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) (hazard ratio (HR) 1.284), maximum tumoral diameter (HR 1.100), plasma total bilirubin (HR 1.119), aspartate amino transferase assessed as multiple of the upper normal value (HR 1.032), alpha-fetoprotein ≥200 ng/mL (HR 1.342), hemoglobin (HR 0.903) and platelet count (HR 1.002) were associated with OS at multivariate Cox regression analysis. Drug response was predicted by maximum tumoral diameter and platelet count. A novel prognostic nomogram for patients undergoing Sorafenib is hereby proposed. The novelty introduced is the comprehensive patient’s assessment using common markers of patient’s general status, liver damage and function and HCC biology. Further studies are required to test its accuracy and provide external validation.

Impact of psoas muscle index assessed by a simple measurement method on tolerability and duration of continued treatment with sorafenib in hepatocellular carcinoma patients

“…Similar to the association with clinical factors and sorafenib tolerability shown in our results for TTF and OS, several previous studies have described the association between OS in HCC patients receiving sorafenib treatment and age, BCLC stage and DCP [36][37][38]. In this study, to avoid the confounding effect of the method used to assess hepatic reserve, we performed additional multivariate analysis including modified albumin-bilirubin (mALBI) grade as a background factor reflecting hepatic reserve function, instead of CP score, as shown in the supplementary tables, Supplemental digital content 1, http:// links.lww.com/EJGH/A744.…”

Myosteatosis can Predict Unfavorable Outcomes in Advanced Hepatocellular Carcinoma Patients Treated With Hepatic Artery Infusion Chemotherapy and Anti-PD-1 Immunotherapy

“…In addition, the modest differentiation efficiency of our model was also attributed to the introduction of several clinical and radiological parameters, including RBC, HGB, Scr, and VFmean, whose potential prognostic roles were investigated in previous studies. For example, RBC ( 26 ) and HGB ( 27 ) have been shown to be critical risk factors for poor prognosis in HCC patients. Relatively reduced Scr level in the Non-OR group when compared to that in the OR group suggested a significant loss of skeleton muscle mass (sarcopenia), which was clearly visible in our cohort and was reported to be associated with the poor prognosis in HCC.…”

Preoperative aspartate aminotransferase to albumin ratio correlates with tumor characteristics and predicts outcome of hepatocellular carcinoma patients after curative hepatectomy: a multicenter study

“…In the present study, patients in the high AAR group had higher serum TBIL level. Elevated TBIL indicates a higher rate of postoperative mortality and long-term survival [ 20 ] and its combination with ALB has shown good predictive ability for HCC patients after surgery [ 6 ].…”