Clinical Utility of a Prognostic Scoring System Based on LDH and CRP in HCC Patients Receiving Atezolizumab Plus Bevacizumab

AIM/BACKGROUND: This study aimed to validate the CLEAR score, a simple prognostic tool for hepatocellular carcinoma (HCC) patients undergoing atezolizumab plus bevacizumab (Atez/Bev) therapy, based on serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) levels. MATERIALS/METHODS: From 2020 to 2023, 498 Japanese HCC patients receiving Atez/Bev therapy were enrolled. They were divided into a training set (n = 280; 13 designated cancer care hospitals) and a validation set (n = 218; 11 universities and their affiliated Japanese hospitals). In the training set, prognostic factors were analysed, leading to the development of the CLEAR score, which was then evaluated on the validation set. RESULTS: Baseline LDH beyond the upper normal limit (hazard ratio [HR] 1.97, 95% CI 1.48-2.64) and CRP (≥ 0.50 mg/dL) (HR 1.61, 95% CI 1.19-2.00) were identified as independent prognostic factors on multivariate analysis and used in the CLEAR score. In the training set, the median progression-free survival (PFS) times in patients with scores 0, 1 and 2 were 11.1 months, 9.1 months and 3.3 months, respectively (p < 0.001). The median overall survival (OS) times in patients with scores 0, 1 and 2 were not available, 15.3 months and 10.6 months, respectively (p < 0.001). Similar results were obtained in the validation set (median PFS and OS times for scores 0, 1 and 2 = 9.4, 6.9 and 4.3 and 30.6, 20.8 and 8.9 months, respectively, each p < 0.001). CONCLUSION: The CLEAR score provides a distinct and simple prediction of the prognosis of HCC patients receiving Atez/Bev therapy.