Aim: This study aimed to evaluate the ability of a previously reported tumor marker (TM) score involving alpha-fetoprotein (AFP), fucosylated AFP (AFP-L3), and des gamma-carboxy prothrombin (DCP) as TMs in predicting the prognosis and therapeutic efficacy in hepatocellular carcinoma (HCC) patients administered atezolizumab plus bevacizumab (Atez/Bev) as first-line treatment. Materials/Methods: The study period covered September 2020 to December 2022 and involved 371 HCC patients treated with Atez/Bev. The values of the TMs AFP, AFP-L3, and DCP were measured upon introducing Atez/Bev. Elevations in the values of AFP (≥100 ng/mL), AFP-L3 (≥10%), and DCP (≥100 mAU/mL) were considered to indicate a positive TM. The number of positive TMs was summed up and used as the TM score, as previously proposed. Hepatic reserve function was assessed using the modified albumin–bilirubin grade (mALBI). Predictive values for prognosis were evaluated retrospectively. Results: A TM score of 0 was shown in 81 HCC patients (21.8%), 1 in 110 (29.6%), 2 in 112 (29.9%), and 3 in 68 (18.3%). The median overall survival (OS) times for TM scores 0, 1, 2, and 3 were not applicable [NA] (95% CI NA-NA), 24.0 months (95% CI 17.8-NA), 16.7 months (95% CI 17.8-NA), and NA (95% CI 8.3-NA), respectively (p< 0.001). The median progression-free survival (PFS) times for TM scores 0, 1, 2, and 3 were 16.5 months (95% CI 8.0-not applicable [NA]), 13.8 months (95% CI 10.6–21.3), 7.7 months (95% CI 5.3–8.9), and 5.8 months (95% CI 3.0–7.6), respectively (p< 0.001). OS was well stratified in mALBI 1/2a and mALBI 2a/2b. PFS was well stratified in mALBI 2a/2b, but not in mALBI 1/2a. Conclusions: The TM score involving AFP, AFP-L3, and DCP as TMs was useful in predicting the prognosis and therapeutic efficacy in terms of OS and PFS in HCC patients administered Atez/Bev as first-line treatment.
目的：本研究旨在评估一项已报道的、包含甲胎蛋白（AFP）、岩藻糖基化甲胎蛋白（AFP-L3）和脱-γ-羧基凝血酶原（DCP）作为肿瘤标志物的评分系统（TM评分）在预测接受阿替利珠单抗联合贝伐珠单抗（Atez/Bev）作为一线治疗的肝细胞癌（HCC）患者预后和治疗疗效方面的能力。 材料与方法：研究时间为2020年9月至2022年12月，共纳入371例接受Atez/Bev治疗的HCC患者。在开始Atez/Bev治疗时测量肿瘤标志物AFP、AFP-L3和DCP的数值。将AFP（≥100 ng/mL）、AFP-L3（≥10%）和DCP（≥100 mAU/mL）的升高视为肿瘤标志物阳性。如先前研究所提出，将阳性肿瘤标志物的数量相加作为TM评分。使用改良的白蛋白-胆红素分级（mALBI）评估肝脏储备功能。对预后预测价值进行回顾性评估。 结果：81例（21.8%）HCC患者的TM评分为0分，110例（29.6%）为1分，112例（29.9%）为2分，68例（18.3%）为3分。TM评分为0、1、2、3分患者的中位总生存期（OS）分别为不适用[NA]（95% CI NA-NA）、24.0个月（95% CI 17.8-NA）、16.7个月（95% CI 17.8-NA）和NA（95% CI 8.3-NA）（p < 0.001）。TM评分为0、1、2、3分患者的中位无进展生存期（PFS）分别为16.5个月（95% CI 8.0-不适用[NA]）、13.8个月（95% CI 10.6–21.3）、7.7个月（95% CI 5.3–8.9）和5.8个月（95% CI 3.0–7.6）（p < 0.001）。在mALBI 1/2a和mALBI 2a/2b分级中，OS均得到良好分层。PFS在mALBI 2a/2b分级中得到良好分层，但在mALBI 1/2a分级中未得到良好分层。 结论：包含AFP、AFP-L3和DCP作为肿瘤标志物的TM评分，可用于预测接受Atez/Bev作为一线治疗的HCC患者在总生存期和无进展生存期方面的预后和治疗疗效。
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