Alpha-fetoprotein combined with initial tumor shape irregularity in predicting the survival of patients with advanced hepatocellular carcinoma treated with immune-checkpoint inhibitors: a retrospective multi-center cohort study

Immune checkpoint inhibitors (ICIs) are playing a significant role in the treatment of hepatocellular carcinoma (HCC). This study aims to explore the prognostic value of alpha-fetoprotein (AFP) and initial tumor shape irregularity in patients treated with ICIs.

In this retrospective, multi-center study, 296 HCC patients were randomly divided into the training set and the validation set in a 3:2 ratio. The training set was used to evaluate prognostic factors and to develop an easily applicable ATSI (AFP and Tumor Shape Irregularity) score, which was verified in the validation set.

The ATSI score was developed from two independent prognostic risk factors: baseline AFP ≥ 400 ng/ml (HR 1.73, 95% CI 1.01–2.96, P = 0.046) and initial tumor shape irregularity (HR 1.94, 95% CI 1.03–3.65, P = 0.041). The median overall survival (OS) was not reached (95% CI 28.20–NA) in patients who met no criteria (0 points), 25.8 months (95% CI 14.17–NA) in patients who met one criterion (1 point), and 17.03 months (95% CI 11.73–23.83) in patients who met two criteria (2 points) (P = 0.001). The median progression-free survival (PFS) was 10.83 months (95% CI 9.27–14.33) for 0 points, 8.03 months (95% CI 6.77–10.57) for 1 point, and 5.03 months (95% CI 3.83–9.67) for 2 points (P < 0.001). The validation set effectively verified these results (median OS, 37.43/24.27/14.03 months for 0/1/2 points, P = 0.028; median PFS, 13.93/8.30/4.90 months for 0/1/2 points, P < 0.001).

The ATSI score can effectively predict prognosis in HCC patients receiving ICIs.