The BCLC-CRAFITY model as a novel efficacy predictor for hepatocellular carcinoma treated with curative radiofrequency ablation followed by adjuvant immunotherapy: A retrospective cohort study
Xuexia Liang, Yanhui Jiang, Yun Deng, Qiaodan Liu, Shuqin Zhu, Youjuan Tang, Wuzhu Lu, Xiqiang LiuBackground
There remains a clear gap in current clinical practice for biomarker-based prognostic models capable of predicting survival outcomes in patients with hepatocellular carcinoma (HCC) who undergo curative radiofrequency ablation (RFA), with or without adjuvant immunotherapy, and for guiding subsequent individualized treatment strategies.
Objectives
This study aimed to evaluate the prognostic value of the C-Reactive Protein and Alpha-Fetoprotein in ImmunoTherapY (CRAFITY) score in patients with HCC treated by curative RFA, and to develop a novel prognostic model.
Design
A retrospective cohort study.
Methods
Clinical variables were evaluated using univariate and multivariate Cox regression analyses. A novel prognostic model was subsequently developed based on independent risk factors identified from these analyses. The predictive performance of the Barcelona Clinic Liver Cancer (BCLC) staging system, the CRAFITY score and the newly established model were compared using receiver operating characteristics (ROC) curves and calibration curves.
Results
A total of 274 patients were enrolled in the training cohort, and 117 patients were included in the validation cohort. Both the BCLC staging system and the CRAFITY score were identified as independent predictors of overall survival (OS). A novel predictive model, designated as the BCLC-CRAFITY score, was subsequently developed based on these independent predictors of OS. The BCLC-CRAFITY model demonstrated superior performance in predicting both OS and recurrence-free survival (RFS) compared with the BCLC staging system or the CRAFITY score alone. Notably, adjuvant therapy with immune checkpoint inhibitor plus antiangiogenic targeted agent (ICI-AA) following curative RFA did not improve RFS among HCC patients stratified into the high-risk group by the BCLC-CRAFITY model.
Conclusions
The BCLC-CRAFITY model showed preliminary predictive promise; nevertheless, its clinical utility in guiding treatment decision warrants further validation through prospective studies.