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The GRAPHS-CRAFITY score: a novel efficacy predictive tool for unresectable hepatocellular carcinoma treated with immunotherapy

  • Abdominal Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Objectives

To investigate MR features associated with prognosis of unresectable HCC receiving immunotherapy and establish a MR feature-based scoring system to predict efficacy of immunotherapy.

Methods

This retrospective study included patients with unresectable HCC who received immunotherapy at 2 hospitals between August 2018 and February 2022. The last follow-up was October 2022. Clinical variables and MR features were assessed using univariate and multivariate Cox regression analyses. A new scoring system was constructed based on independent risk factors and the CRAFITY score consisting of AFP (≥ 100 ng/ml) and CRP (≥ 1 mg/dl). And the predictive performance of CRAFITY core and new score were compared by receiver-operating-characteristics curves (ROCs), area under ROCs (AUCs), and calibration curves.

Results

A total of 166 patients (55.6 ± 10.4 years) were included in training cohort and 77 patients (55.4 ± 10.7 years) were included in validation cohort. There were significant differences in BCLC stage, max size, macrovascular invasion, intratumoral artery, and enhancing capsule between the 2 groups. Based on independent risk factors (gross GRowtH type, intratumoral fAt, enhancing tumor caPsule, Sex and CRAFITY score), a novel efficacy predictive tool named the GRAPHS-CRAFITY score was developed to predict OS. The OS was significantly different among the 3 groups according to GRAPHS-CRAFITY score (p value < 0.001). The GRAPHS-CRAFITY score could predict tumor response and disease control (p value < 0.001, p value < 0.001).

Conclusions

The GRAPHS-CRAFITY score is a reliable and easily applicable tool to predict the efficacy of unresectable HCC receiving immunotherapy.

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Data availability

The datasets underlying this study are available on request to the corresponding author. Requests to access these datasets could be directed to yefeng@cicams.ac.cn and zhaohong@cicams.ac.cn.

Abbreviations

AFP:

Alpha-fetoprotein

AUC:

Area under the receiver-operating characteristic curve

BCLC:

Barcelona clinic liver cancer

CI:

Confidence intervals

CR:

Complete response

CRP:

C-reactive protein

ECOG PS:

Eastern cooperative oncology group performance status

HCC:

Hepatocellular carcinoma

MR:

Magnetic resonance

mRECIST:

Modified response evaluation criteria in solid tumors

ORR:

Objective response rate

OS:

Overall survival

PD:

Progressive disease

PD-(L)1:

Programmed death (ligand) 1

PFS:

Progression free survival

PR:

Partial response

SD:

Stable disease

T-AUC:

Time-dependent area under the receiver-operating characteristic curve

TKI:

Tyrosine kinase inhibitor

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Funding

This study was supported by the National Natural Science Foundation of China (No. 81972311, 82141127), the CAMS Innovation Fund for Medical Sciences (CIFMS) (2022-I2M-C&T-B-081), the Special Research Fund for Central Universities, Peking Union Medical College (No. 3332022026) and the Youth Project of Beijing Hope Marathon Special Fund (No. LC2021B17).

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Author notes

  1. Yi Yang, Lu Li, Ying Xu, Jingzhong Ouyang, and Yanzhao Zhou have contributed equally to this work.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yi Yang, Jingzhong Ouyang, Zhen Huang, Jianqiang Cai & Hong Zhao

  2. Key Laboratory of Gene Editing Screening and Research and Development (R&D) of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yi Yang, Jingzhong Ouyang, Zhen Huang, Jianqiang Cai & Hong Zhao

  3. Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Lu Li, Ying Xu, Feng Ye & Xinming Zhao

  4. Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China

    Yanzhao Zhou & Jinxue Zhou

  5. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Wen Zhang & Aiping Zhou

  6. Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Yong Wang

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Contributions

(I) HZ, YW, JZ, and FY contributed to conception and design; (II) JC, HZ, XZ, YW, AZ, JZ, and FY involved in administrative support; (III) JC, HZ, XZ, YW, JZ, FY, AZ, WZ, and ZH gave provision of study materials or patients; (IV) YY, LL, YX, JO, and YZ involved in collection and assembly of data; (V) YY, LL, YX, JO, and YZ involved in data analysis and interpretation; (VI) YY, LL, YX, JO, and YZ involved in manuscript writing; (VII) all authors gave final approval of manuscript.

Corresponding authors

Correspondence to Feng Ye, Yong Wang, Jinxue Zhou or Hong Zhao.

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All authors have completed the ICMJE uniform disclosure form and have no conflicts of interest to declare. The authors disclosed no relevant relationships.

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The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This retrospective study was conducted in accordance with the Declaration of Helsinki (as revised in 2013) and was approved by the independent ethics committee of each center. Written informed consent for treatment was obtained from all patients before receiving systematic therapy. Informed consent to conduct the study was waived by the ethics committee, owing to its retrospective study.

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Yang, Y., Li, L., Xu, Y. et al. The GRAPHS-CRAFITY score: a novel efficacy predictive tool for unresectable hepatocellular carcinoma treated with immunotherapy. Radiol med 129, 188–201 (2024). https://doi.org/10.1007/s11547-023-01753-z

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