Comparison of Prognostic Scores in Patients With Hepatocellular Carcinoma Treated With Sorafenib

Abstract

INTRODUCTION: Prognostic classifications for patients treated with sorafenib for hepatocellular carcinoma (HCC) facilitate stratification in trials and inform clinical decision making. Recently, 3 different prognostic models (hepatoma arterial-embolization prognosis [HAP] score, sorafenib advanced HCC prognosis [SAP] score, and Prediction Of Survival in Advanced Sorafenib-treated HCC [PROSASH]-II) have been proposed specifically for patients treated with sorafenib. This study aimed to compare the prognostic performance of different scores. METHODS: We analyzed a large prospective database gathering data of 552 patients treated with sorafenib from 7 Italian centers. The performance of the HAP, SAP, and PROSASH–II models were compared with those of generic HCC prognostic models (including the Barcelona Clinic for Liver Cancer and Italian Liver Cancer staging systems, albumin–bilirubin grade, and Child-Pugh score) to verify whether they could provide additional information. RESULTS: The PROSASH-II model improved discrimination (C-index 0.62) compared with existing prognostic scores (C-index ≤0.59). Its stratification significantly discriminated patients, with a median overall survival of 21.5, 15.3, 9.3, and 6.0 months for risk group 1, 2, 3, and 4, respectively. The HAP and SAP score were also validated but with a poorer performance compared with the PROSASH-II. DISCUSSION: Although suboptimal, PROSASH-II is the most effective prognostic classification model among other available scores in a large Italian population of patients treated with sorafenib.

Experience with regorafenib in the treatment of hepatocellular carcinoma

“…Advanced HCC is a lethal malignancy, and, as of 2007, for HCC patients having retained liver function with advanced Barcelona Clinic Liver Cancer (BCLC) stage and who are not eligible for locoregional treatment, the multikinase inhibitor (MKI) sorafenib has been established as the standard of care worldwide. 12 …”

Durable objective response to sorafenib and role of sequential treatment in unresectable hepatocellular carcinoma

“…PROSASH-II score was suggested as the most-effective prognostic classification model for patients with sorafenib-treated HCC. 22 However, no significant survival difference could be identified according to PROSASH-II model in our objective responders. It is possible that our patients were objective responders to sorafenib; consequently, PROSASH-II scores could not further differentiate them.…”

“…We also applied Prediction Of Survival in Advanced Sorafenib-treated HCC (PROSASH)-II score to differentiate OS of our patients. 22 In addition, Cox’s proportional-hazard model was used to identify prognostic factors for survival. Schoenfeld residuals were used to test the assumption of proportional hazards ( Supplemental Figure 1 ); p < 0.05 was considered statistically significant for all analyses.…”

Case Report: Durable Response to Very Low Dose Tyrosine Kinase Inhibitors in Advanced Hepatocellular Carcinoma

“…Dedicated studies with larger cohorts closely examining the timing of onset for HFSR in conjunction with usage of low dose TKI’s could provide further clinical information clarifying this association’s prognostic value. At current, the PROSASH-II score is the only validated prognostic tool in the context of sorafenib response and does not include timing of onset for HFSR ( 13 ).…”