Predicting early progression to atezolizumab-bevacizumab in hepatocellular carcinoma: a clinical and imaging-based scoring system.

[OBJECTIVES] To develop a predictive model incorporating both clinical and imaging findings to predict early progression in patients with advanced hepatocellular carcinoma (HCC) undergoing atezolizumab plus bevacizumab (Atezo-Bev) therapy.

[MATERIALS AND METHODS] A total of 140 consecutive patients with HCC who initiated Atezo-Bev therapy between January 2020 and May 2022 at two tertiary care centres were retrospectively enrolled. Early progression was defined as progressive disease in the first response evaluation conducted at 4 weeks and 12 weeks after treatment initiation using dynamic CT or MRI. Images were reviewed by two radiologists. Logistic regression analysis was performed to determine the early progression scores.

[RESULTS] The first response evaluation of Atezo-Bev therapy was conducted at a median of 56 days (interquartile range, 42-64 days) after treatment initiation. Approximately 40% (56/140) of patients with HCC showed early progression. The early progression score was defined as follows: (age < 60 years; 1 point) + (serum alpha-fetoprotein level ≥ 300 ng/mL; 3 points) + (neutrophil-to-lymphocyte ratio ≥ 2.8; 1 point) + (infiltrative appearance; 2 points). At a score of 3 or higher, the early progression score showed sensitivity of 91.1% (95% confidence interval [CI]: 83.6-98.5%) and a specificity of 53.6% (95% CI: 42.9-64.2%). At a score of 6 or higher, the score demonstrated a sensitivity of 55.4% (95% CI: 42.3-68.4%) and a specificity of 91.7% (95% CI: 85.8-97.6%).

[CONCLUSION] We developed an early progression score that integrates clinical and imaging factors with high specificity to accurately predict early progression in patients with advanced HCC undergoing Atezo-Bev therapy.

[KEY POINTS] Question No validated imaging-based tool currently exists to predict early progression to Atezo-Bev therapy in advanced HCC. Findings Infiltrative tumour appearance, high AFP, high neutrophil-to-lymphocyte ratio, and younger age were significantly associated with early progression. Clinical relevance A composite early progression score integrating clinical and imaging features showed high diagnostic accuracy for predicting treatment failure.