Identification of Atezolizumab Plus Bevacizumab Prognostic Index via Recursive Partitioning Analysis in HCC: The ABE Index

Anticancer Res. 2023 Apr;43(4):1599-1610. doi: 10.21873/anticanres.16310.

Abstract

Background/aim: The purpose of this study was to ascertain a novel prognostic index via recursive partitioning analysis (RPA) in hepatocellular carcinoma (HCC) patients being treated with the combination of atezolizumab plus bevacizumab (ABE) in first-line setting.

Patients and methods: A total of 784 patients with HCC were included in the analysis.

Results: RPA identified three groups of patients: high-risk [Child-Pugh B (CP-B) patients; CP-A and Albumin-Bilirubin (ALBI)-2 patients; CP-A and ALBI-1 patients with macrovascular invasion (MVI), and alpha-fetoprotein (α-FP) ≥400 ng/ml]; intermediate-risk [CP-A and ALBI-1 patients with aspartate aminotransferase (AST) normal value (NV), and αFP ≥400 ng/ml, but without MVI; CP-A and ALBI-1 patients with AST increased value (IV), and neutrophil-lymphocyte ratio (NLR) ≥3, but without MVI]; low-risk (CP-A and ALBI-1 patients with AST NV, and αFP <400 ng/ml, but without MVI; CP-A and ALBI-1 patients with AST IV, and NLR <3, but without MVI; CP-A and ALBI-1 patients with MVI, and αFP <400 ng/ml). Overall survival was 7.0 months in high-risk patients (20.8%), 14.2 months in intermediate-risk patients (19.1%), and 22.5 months in low-risk patients (60.1%).

Conclusion: The ABE index allows for easy stratification of HCC patients treated with the combination of ABE in first-line setting.

Keywords: ABE index; advanced hepatocellular carcinoma; atezolizumab plus bevacizumab; recursive partitioning analysis.

MeSH terms

  • Bevacizumab / therapeutic use
  • Bilirubin
  • Carcinoma, Hepatocellular* / pathology
  • Humans
  • Liver Neoplasms* / pathology
  • Prognosis
  • Retrospective Studies
  • Serum Albumin

Substances

  • atezolizumab
  • Bevacizumab
  • Serum Albumin
  • Bilirubin