Prognostic significance of C-reactive protein in unresectable hepatocellular carcinoma treated with atezolizumab and bevacizumab.

Abstract

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), C-reactive protein and alpha fetoprotein in immunotherapy (CRAFITY), and Glasgow Prognostic Score.

RESULTS:

Compared with patients with baseline CRP <1 mg/dL, those with baseline CRP ≥1 mg/dL (n = 45) had a significantly higher baseline albumin-bilirubin score and AFP levels, significantly lower disease control rate (62.2%), and significantly shorter median overall survival (hazards ratios 2.292; 95% confidence interval 1.313-5.107; log-rank test, p < 0.001). Multivariate analysis identified CRP ≥1 mg/dL, AFP ≥100 ng/mL, and modified albumin-bilirubin grade as the significant prognostic factors. The baseline CRP, AFP, CRAFITY, and Glasgow Prognostic Score demonstrated higher discrimination for 1-year survival prediction after first-line ATZ + BEV administration, compared with beyond second line, with area under the receiver operating characteristic curves 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.

• Authors: 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, Ochanomizu Liver Conference Study Group
• Journal: Hepatology research : the official journal of the Japan Society of Hepatology (Hepatol Res) (Dec 22 2023) ISSN: 1386-6346 [Print] Netherlands
• PMID: 38133587 (Publication Type: Journal Article)
• Copyright: © 2023 Japan Society of Hepatology.