Prognostic Significance of C‐Reactive Protein in Unresectable Hepatocellular Carcinoma treated with Atezolizumab and Bevacizumab
Shun Kaneko, Yasuhiro Asahina, Miyako Murakawa, Shunsuke Ueyama, Chiaki Maeyashiki, Hideki Watanabe, Akiko Kusano‐Kitazume, Ayako Sato, Kozue Uchidate, Takehito Asakawa, Sho Watanabe, Yasuhiro Iizuka, Isamu Shibata, Shinya Oooka, Yuko Karakama, Takashi Fujii, Taro Watabe, Keiichi Akahoshi, Minoru Tanabe, Kento Inada, Tomohiro Mochida, Keiya Watakabe, Taro Shimizu, Jun Tsuchiya, Masato Miyoshi, Fukiko Kitahata‐Kawai, Sayuri Nitta, Mina Nakagawa, Sei Kakinuma, Ryuichi Okamoto,- Infectious Diseases
- Hepatology
Abstract
Background/aim
C‐reactive protein (CRP) is both an inflammatory and prognostic marker in various cancers. This study aimed to elucidate the characteristics of CRP and the prognostic factors in patients who were administered with atezolizumab plus bevacizumab (ATZ + BEV) for unresectable hepatocellular carcinoma (HCC).
Methods
A total of 213 patients who received ATZ + BEV for HCC from November 2020 to March 2023 at 15 hospitals were enrolled in this retrospective study. The prognosis was analyzed by subdividing the patients based on baseline characteristics, radiologic response, and treatment lines. Accuracy of survival prediction was assessed using CRP, alpha fetoprotein (AFP), CRP and AFP in immunotherapy (CRAFITY), and Glasgow Prognostic score (GPS).
Results
Compared with patients with baseline CRP <1 mg/dL, those with baseline CRP ≥1 mg/dL (n = 45) had significantly higher baseline albumin–bilirubin (ALBI) score and AFP levels, significantly lower disease control rate (62.2%), and significantly shorter median overall survival (HR 2.292; 95% CI 1.313–5.107; log rank test, P <0.001). Multivariate analysis identified CRP ≥1 mg/dL, AFP ≥100 ng/mL, and modified ALBI grade as the significant prognostic factors. The baseline CRP, AFP, CRAFITY, and GPS demonstrated higher discrimination for one‐year survival prediction after first line ATZ + BEV administration, compared with beyond second line, with AUROCs of 0.759, 0.761, 0.805, and 0.717, respectively.
Conclusions
CRP was a significant biomarker in patients treated with ATZ + BEV for HCC. Elevated CRP levels may indicate aggressive cancer progression and potential resistance to ATZ + BEV therapy.
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