Novel score predicts survival, radiological response in HCC

The novel CRAFITY score—which takes into account C-reactive protein (CRP), alpha-foetoprotein (AFP), and immunotherapy—can be used to reliably assess survival and radiological response in hepatocellular carcinoma (HCC), a recent study has found. Future validation is needed before CRAFITY can be deployed to the clinics.

The score was first developed in a training set including 190 HCC patients put on programmed death ligand-1-based immunotherapy. Median overall survival (OS) was 11.0 months.

Multivariable modelling showed that Child-Pugh stage (hazard ratio [HR], 2.3, 95 percent confidence interval [CI], 1.5–3.4), performance status (HR, 2.1, 95 percent CI, 1.4–3.2), AFP <100 ng/mL (HR, 1.7, 95 percent CI, 1.2–2.6), and CRP <1 mg/dL (HR, 1.7, 95 percent CI, 1.2–2.6) were significant and independent prognostic factors.

Such findings led the researchers to develop a prognostic score, based on CRP, AFP, and immunotherapy status, called CRAFITY. Compared with the low CRAFITY score group (median score 0), those with intermediate (median score 1; HR, 2.0, 95 percent CI, 1.1–3.4) and high (median score 2; HR, 3.6, 95 percent CI, 2.1–6.2) scores saw significantly higher risks of death. Low CRAFITY scores also correlated with better radiological response.

The researchers then sought to validate CRAFITY in an independent external cohort consisting of 102 HCC patients treated with immunotherapy. As in the training set, median OS was better in patients with low vs intermediate and high CRAFITY scores (21.7 vs 13.9 and 8.4 months; p=0.001). The same was true for radiological response.

“The score could aid in the selection of patients for clinical trial inclusion and support decision-making in daily clinical practice. The score warrants prospective validation in a large clinical study, ideally with an active control not treated with immunotherapy,” the researchers said.