CRAFITY and AFP/PIVKA-II Kinetics Predict Prognosis in Hepatocellular Carcinoma on Immunotherapy.

IF 4.4 2区医学 Q1 ONCOLOGY

Cancers Pub Date : 2025-09-18 DOI:10.3390/cancers17183058

Shou-Wu Lee, Yi-Jie Huang, Ying-Cheng Lin, Hsin-Ju Tsai, Chia-Chang Chen, Chung-Hsin Chang, Teng-Yu Lee, Yen-Chun Peng

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引用次数: 0

Abstract

Background: The CRAFITY score, integrating baseline C-reactive protein (CRP) and alpha-fetoprotein (AFP), has been validated as a prognostic biomarker in hepatocellular carcinoma (HCC) treated with immunotherapy, but many patients present with non-elevated AFP, limiting its accuracy. This study evaluated a composite model incorporating the CRAFITY score with AFP/PIVKA-II kinetic changes.

Methods: We retrospectively enrolled 69 patients with unresectable HCC (BCLC stage B/C) receiving immunotherapy between September 2021 and June 2023. Baseline CRP, AFP, and PIVKA-II, as well as 4-week changes, were recorded. The CRAFITY-100 RULE combined CRAFITY (0-2) with AFP/PIVKA-II kinetics (0-3), yielding three risk levels (I-III). Clinical outcomes included objective response (OR) and overall survival (OS).

Results: Of the cohort, 10 (14.5%), 29 (42%), and 30 (43.5%) patients had CRAFITY scores 0, 1, and 2, respectively, but this score did not clearly stratify OS (median 24, 12, and 15 months; p = 0.267). In contrast, the CRAFITY-100 RULE classified 5 (7.3%), 35 (50.7%), and 29 (42%) patients into levels I-III, respectively, with significantly different survival (median OS 24, 15, and 7 months; p = 0.048). OR rates were lowest at level III (17%). Time-dependent ROC analysis confirmed superior discrimination of CRAFITY-100 RULE over CRAFITY scores at 6 months (AUROC 0.673 vs. 0.604) and 12 months (0.732 vs. 0.656).

Conclusions: The CRAFITY-100 RULE provided clearer stratification and higher discrimination. This simple model integrating baseline and dynamic biomarkers may assist clinical decision-making in unresectable HCC treated with immunotherapy.

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肝癌免疫治疗的狡猾和AFP/PIVKA-II动力学预测预后。

背景：综合基线c反应蛋白（CRP）和甲胎蛋白（AFP）的CRAFITY评分已被证实为免疫治疗肝细胞癌（HCC）的预后生物标志物，但许多患者存在非升高的AFP，限制了其准确性。本研究评估了结合CRAFITY评分和AFP/PIVKA-II动力学变化的复合模型。方法：我们回顾性招募了69例不可切除的HCC （BCLC B/C期）患者，于2021年9月至2023年6月期间接受免疫治疗。记录基线CRP、AFP和PIVKA-II，以及4周的变化。CRAFITY-100规则结合了CRAFITY（0-2）和AFP/PIVKA-II动力学（0-3），产生了三个风险级别（I-III）。临床结果包括客观缓解（OR）和总生存期（OS）。结果：在队列中，分别有10例（14.5%）、29例（42%）和30例（43.5%）患者的CRAFITY评分为0、1和2，但该评分并没有明确的OS分层（中位24、12和15个月；p = 0.267）。相比之下，craft -100 RULE将5例（7.3%）、35例（50.7%）和29例（42%）患者分别分为I-III级，其生存期存在显著差异（中位OS为24、15和7个月；p = 0.048）。III期OR率最低（17%）。时间相关的ROC分析证实，CRAFITY-100 RULE在6个月时（AUROC为0.673比0.604）和12个月时（0.732比0.656）优于CRAFITY评分。结论：CRAFITY-100规则分层更清晰，区分度更高。这个简单的模型整合了基线和动态生物标志物，可能有助于免疫疗法治疗不可切除HCC的临床决策。

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来源期刊

Cancers Medicine-Oncology

CiteScore

8.00

自引率

9.60%

发文量

5371

审稿时长

18.07 days

期刊介绍： Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.