Combination of systemic immune-inflammation index and albumin-bilirubin grade predict prognosis of regorafenib in unresectable hepatocellular carcinoma

Wei Teng; Tai-An Cheng; Po-Ting Lin; Chen-Chun Lin; Chun-Yen Lin; Shi-Ming Lin

Combination of systemic immune-inflammation index and albumin-bilirubin grade predict prognosis of regorafenib in unresectable hepatocellular carcinoma

Am J Cancer Res. 2023 Jun 15;13(6):2702-2713. eCollection 2023.

Authors

Wei Teng^{1

2

3}, Tai-An Cheng¹, Po-Ting Lin^{1

2

3}, Chen-Chun Lin^{1

2

3}, Chun-Yen Lin^{1

2

3}, Shi-Ming Lin^{1

2

3}

Affiliations

¹ Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
² Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center Taoyuan, Taiwan.
³ College of Medicine, Chang Gung University Taoyuan, Taiwan.

PMID: 37424826
PMCID: PMC10326579

Abstract

Regorafenib improved prognosis for unresectable hepatocellular carcinoma (uHCC) after sorafenib treatment failure. We aimed to investigate prognostic value of combining systemic inflammatory markers with liver function evaluation in patients receiving sorafenib-regorafenib sequential therapy. A total of 122 uHCC patients who received sorafenib-regorafenib sequential therapy were retrospectively enrolled for analysis. The pre-treatment preserving liver function and six inflammatory indexes were collected. The Cox regression model was used to identify independent predictors of progression-free survival (PFS) and overall survival (OS). Baseline ALBI grade I (hazard ratio (HR) = 0.725, P = 0.040 for PFS; HR = 0.382, P = 0.012 for OS) and systemic inflammatory index (SII) ≤ 330 (HR = 0.341, P = 0.017 for OS; HR = 0.485, P = 0.037 for OS) were identified as independent prognostic factors in multivariable analysis and were used to develop the scoring system. Patients who fulfilled both criteria (2 points; score-high) had the longest median PFS (not-reached) and OS (not-reached), followed by fulfilling 1 criterion (1 point; score-intermediate; PFS: 3.7 months and OS: 17.9 months), and patients fulfilled no criterion (0 point; score-low; PFS: 2.9 months, overall log-rank P = 0.001 and OS: 7.5 months, overall log-rank P = 0.003). Additionally, best radiological response was significantly higher in patients with score-high (complete response/partial response/stable disease/progressive disease: score-high: 5.9%/5.9%/58.8%/29.4% vs. score-intermediate: 0%/14.0%/44.2%/41.9% vs. score-low: 0%/0%/25.0%/75.0%; P = 0.011). In conclusion, a combination of baseline ALBI grade and SII index can be used as a simple and powerful parameter to predict prognosis of uHCC patients receiving regorafenib after sorafenib-refractory treatment. The score may help with patient counseling but requires prospective validation.

Keywords: ALBI grade; Hepatocellular carcinoma; prognosis; sequential therapy; systemic inflammatory index.