Prognostic Value of Clinical and CT Features in Camrelizumab Plus Apatinib Treatment for Unresectable Hepatocellular Carcinoma

Jinlian Che,1,2,* Yidi Chen,2,* Zhiming Zeng,3 Chenhui Li,2 Ling Zhang,2 Xialing Huang,2 Fuling Huang,2 Yingfei Wang,1 Weibao Huang,1 Bin Song,4,5 Liling Long2 1Department of Radiology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People’s Republic of China; 2Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 3Department of Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 4Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 5Department of Radiology, Sanya People’s Hospital, Sanya, Hainan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Liling Long, Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning, Guangxi, People’s Republic of China, 530021, Tel +86 13807712604, Email [email protected]: Immunotherapy combined with targeted therapy is a key approach for patients with unresectable hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic value of clinical and CT features in Camrelizumab plus Apatinib treatment for these patients.Materials and Methods: A retrospective study was conducted on unresectable HCC patients who received camrelizumab plus Apatinib treatment from June 2019 to August 2021. Clinical and contrast-enhanced CT features were analyzed. Logistic regression identified predictors of objective response, and Cox regression assessed prognostic factors for progression-free survival (PFS) and overall survival (OS). Nomograms were constructed based on independent predictors.Results: Among 109 patients, the median OS was 20 months, median PFS was 9 months, and the ORR was 43.1%. Independent predictors of objective response included AFP ≥ 400 ng/mL (OR = 6.31), NLR ≥ 3.2 (OR = 3.72), tumor numbers ≥ 3 (OR = 3.93), and ΔAER < 15% (OR = 10.99), the AUC for objective response model was 0.874. Independent factors for PFS included AFP ≥ 400 ng/mL (HR = 2.04) and ΔAER < 15% (HR = 2.57), resulting in a model AUC of 0.859. Independent factors for OS were NLR ≥ 3.2 (HR = 2.07), Tumor numbers ≥ 3 (HR = 2.68), and extrahepatic metastasis (HR = 2.32), with an AUC of 0.848 and 0.866 for 1- and 2-year survival, respectively.Conclusion: Clinical and contrast-enhanced show significant prognostic value in patients receiving Camrelizumab plus Apatinib. The developed models may assist in identifying responsive patients and personalizing treatment strategies.Keywords: hepatocellular carcinoma, immunotherapy, targeted therapy, computerized tomography, objective response rate