Prognostic impact of CRAFITY score in hepatocellular carcinoma patients treated with immune checkpoint inhibitors

Immune checkpoint inhibitors (ICIs) have transformed the treatment landscape of hepatocellular carcinoma (HCC), yet identifying patients most likely to benefit remains challenging. We evaluated the prognostic significance of the C-reactive protein and alpha-fetoprotein in immunotherapy (CRAFITY) score, a composite index integrating C-reactive protein and alpha-fetoprotein, in HCC treated with ICIs. A systematic review and meta-analysis of 17 studies comprising 3,730 patients demonstrated that higher baseline CRAFITY scores were consistently associated with shorter overall and progression-free survival, as well as lower response and disease control rates. Complementing these findings, a retrospective analysis of 129 ICI-treated patients at our institution confirmed that elevated CRAFITY scores predicted significantly poorer survival outcomes. These results highlight the CRAFITY score as a simple, readily available biomarker that captures systemic inflammation and tumor burden, enabling more precise prognostic stratification and potentially guiding therapeutic decision-making in patients receiving immunotherapy for advanced HCC.