Prediction of treatment response and survival in patients with advanced hepatocellular carcinoma receiving sorafenib: pretreatment prognostic scores

INTRODUCTION: Sorafenib is currently among the recommended first-line medications for patients with advanced hepatocellular carcinoma (HCC); however, response to sorafenib remains unpredictable despite efforts to define prognosis. This study aims to predict treatment response and survival in patients with sorafenib-treated HCC using neutrophil-to-lymphocyte ratio (NLR), albumin-bilirubin (ALBI) grade, CRAFITY score, and Glasgow prognostic score (GPS). METHODS: This prospective study recruited 75 Egyptian patients with Sorafenib-treated HCC. Pretreatment laboratory parameters and imaging studies were obtained. The neutrophil-to-lymphocyte ratio, ALBI grade, CRAFITY score, and GPS were calculated for each patient. All the patients were followed for treatment response, overall survival, and sorafenib tolerance. RESULTS: Most of the participants were males, with a median age of 62 years. HCV was the most common underlying cause. Most of the patients had a low pretreatment NLR (77.33%), grade 2 ALBI (65.33%), 41.89% had a high CRAFITY score, and 48.6% had GPS 1. Patients were divided into two groups: group 1: sorafenib-naïve (n = 44) and group 2: patients with previous interventional therapy (n = 31). Pretreatment AST, ALT, mild ascites, portal invasion, and BCLC stage C were significantly higher among sorafenib-naïve patients. Median OS and time to progression for the entire cohort were 4 months and 9 months, respectively. No significant differences were observed in terms of OS between various NLR, ALBI grades, CRAFITY scores, and GPS. Multivariate analysis showed a high risk of mortality among sorafenib-intolerant patients (p = 0.01, HR: 2.33, 95% CI: 1.23-4.42). CONCLUSION: Overall survival and time to progression are not affected by different pretreatment values of NLR, ALBI grade, CRAFITY score, and Glasgow prognostic score in sorafenib-treated HCC.