Prognosis of patients with hepatocellular carcinoma treated with immunotherapy – development and validation of the CRAFITY score

Abstract

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Reply to: “The CRAFITY score: A new guidepost for prognosis prediction in patients with hepatocellular carcinoma undergoing immunotherapy”

“…However, given the lack of scheduled imaging assessments due to the retrospective nature of our study, confirmation of our findings in a prospective cohort with predefined and homogeneous radiological evaluation is required. 2 Secondly, we agree with the authors that histological diagnosis is desirable in all patients with HCC, especially if treated within clinical trials. However, since international guidelines allow for both histological as well as radiological diagnosis in patients with cirrhosis, 4 HCC is still frequently diagnosed by radiology alone in many centers.Notably, we did not generally consider missing radiological follow-up as disease progression.…”

“…Zhou, Yang, and Zhou for their great interest in our paper 1 and for complimenting the design and presentation of our study published in Journal of Hepatology. 2 We are happy to reply to the authors' comments.Firstly, we acknowledge that several prognostic models have been proposed for hepatocellular carcinoma (HCC). However, given that treatment decisions are usually based on radiological evaluation in clinical practice, 3 we aimed to developed a score to not only predict overall survival (OS) but also radiological response in patients with HCC treated with immunotherapy.…”

“…Sensitivity analysis confirmed the difference in radiological response according to CRAFITY subgroups. 2 Thirdly, it was previously shown that increased C-reactive protein (CRP) values with a cut-off of 1 mg/dl were associated with a worse prognosis in HCC, regardless of the cause of CRP elevation (tumor-vs. infection-related). 5 We confirmed this cutoff by using restricted cubic spline analysis.…”

The Predictive Potential of the Baseline C-Reactive Protein Levels for the Efficiency of Immune Checkpoint Inhibitors in Cancer Patients: A Systematic Review and Meta-Analysis

“…The clinical reference cutoff value for CRP is set as 0.5 mg/dl in some studies ( 40 ), but the cutoff value of high baseline CRP level remains controversial and various cutoff values have served in the literature. Our study permitted different cutoff values and the most popular applied cutoff value is still 1.0 mg/dl ( 21 , 24 , 29 , 34 , 35 , 42 , 43 , 47 , 49 – 51 ). The principal cause of the discrepancy in cutoff values is that some studies employed the median CRP level as the cutoff value, just to equalize the number of individuals in the high CRP and low CRP groups.…”

Atezolizumab and bevacizumab for HCC in the real world

“…In this case, the use of AB in this Korean population supports the efficacy of AB in clinical practice. Further real‐world studies are needed in different populations to understand the efficacy in patients who may not fit trial criteria 8 . With increasing treatment options for advanced HCC, the question of how best to choose becomes more difficult.…”