Z Gastroenterol 2021; 59(08): e325
DOI: 10.1055/s-0041-1734228
VORTRÄGE

Predicting the outcome of patients with hepatocellular carcinoma treated with immunotherapy - the CRAFITY score

B Scheiner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
K Pomej
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
MM Kirstein
2   Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
,
F Hucke
3   Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
,
F Finkelmeier
4   Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Germany
,
O Waidmann
5   Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt/Main, Austria
,
K Schulze
6   1. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
,
S Koch
7   Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
,
S Spahn
8   Department Internal Medicine I, Eberhard-Karls University, Tübingen, Germany
,
P Radu
9   Hepatology-Department of Biomedical Research, University of Bern, Bern, Switzerland
,
AR Siebenhüner
10   Department of Medical Oncology and Hematology, University Hospital Zurich and University Zurich, Zürich, Switzerland
,
JC Mertens
11   Department of Hepatology and Gastroenterology, University Hospital Zurich and University Zurich, Zürich, Switzerland
,
NN Rahbari
12   Department of Surgery at University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
F Kütting
13   Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
,
D Waldschmidt
13   Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
,
MP Ebert
14   Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
A Teufel
14   Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
SDe Dossa
15   Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana (USI), Lugano, Switzerland
,
DJ Pinato
16   Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
,
T Meischl
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
L Balcar
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
C Müller
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
T Reiberger
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
,
M Pinter
1   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Vienna, Austria
› Author Affiliations
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    Background Immunotherapy with atezolizumab plus bevacizumab represents the new standard of care in systemic front-line treatment of hepatocellular carcinoma (HCC). Biomarkers to predict treatment success are an unmet need.

    Methods Patients with HCC treated with PD-(L)1-based immunotherapy between July 2015 and May 2020 in 6 European centers (training set; n = 104) and between August 2015 and February 2020 in 7 European centers (validation set; n = 73) were included. We investigated the prognostic value of baseline variables by using a Cox regression model in the training set and developed the CRAFITY (CRP and AFP in ImmunoTherapY) score. The score was validated in the independent, external cohort.

    Results Baseline serum alpha-fetoprotein (AFP) ≥200 ng/ml (HR, 2.0; p = 0.009) and C-reactive protein (CRP) ≥1 mg/dl (HR, 2.0; p < = 0.016) were identified as independent negative prognostic factors in multivariable analysis and were used to develop the CRAFITY score. Patients who fulfilled none or only one criterion (0-1 point; CRAFITY-low) had a significantly longer median overall survival (21.8 (95 %CI, 13.4-30.2) months) than patients meeting both criteria (2 points; CRAFITY-high; 5.3 (95 %CI, 1.9-8.6) months; p < 0.001). Additionally, they had a significantly better disease control rate (70 % vs. 32 %; p = 0.001). These results were confirmed in the independent validation set and remained significant irrespective of Child-Pugh stage and treatment line.

    Conclusions The CRAFITY score identifies patients with favorable disease control and survival. The score may help to guide treatment decisions and patient counseling.


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    Publication History

    Article published online:
    01 September 2021

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