Evidence map›Paper›PMID 40059970›Full record

ArticleJHEP reports : innovation in hepatology2025

Evaluation of prognostic scores in patients with HCC undergoing first-line immunotherapy with atezolizumab and bevacizumab.

Simon Johannes Gairing, Philipp Mildenberger, Jennifer Gile, Fabian Artusa, Bernhard Scheiner, Catherine Leyh, Sabine Lieb, Friedrich Sinner, Vincent Jörg, Thorben Fruendt and 49 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JHEP reports : innovation in hepatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

59 authors.

Simon Johannes GairingDepartment of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Philipp MildenbergerInstitute of Medical Biometry, Epidemiology and Informatics of the Johannes Gutenberg University Mainz, Mainz, Germany.
Jennifer GileDepartment of Oncology, Mayo Clinic, Rochester, MN, USA.
Fabian ArtusaDepartment of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
Bernhard ScheinerDivision of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Catherine LeyhDepartment of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany.
Sabine LiebDepartment of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany.
Friedrich SinnerDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University Hospital, Magdeburg, Germany.
Vincent JörgI. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Thorben FruendtI. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Vera HimmelsbachMedical Clinic 1, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany.
Nada AbedinMedical Clinic 1, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany.
Cennet SahinMedical Department III, University Hospital RWTH Aachen, Aachen, Germany.
Katrin BöttcherClinical Department for Internal Medicine II, Department of Clinical Medicine, TUM School of Medicine and Health, University Medical Center, Technical University of Munich, Germany.
Jasmin SchuhbaurDepartment of Internal Medicine I, University of Ulm, Ulm, Germany.
Simon LabuhnClinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
James KorolewiczDepartment of Surgery & Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Claudia A M FulgenziDepartment of Surgery & Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Antonio D'AlessioDepartment of Surgery & Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Valentina ZanusoDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy.
Florian HuckeDepartment of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Worthersee, Klagenfurt, Kärnten, Austria.
Natascha RöhlenDepartment of Medicine II, Medical Center University of Freiburg, Freiburg, Germany.
Najib Ben KhaledDepartment of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
Eleonora RamadoriDepartment of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany.
Lukas MüllerDepartment of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Arndt WeinmannDepartment of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Roman KloecknerInstitute of Interventional Radiology, University Hospital Schleswig-Holstein, Lübeck, Germany.
Peter Robert GalleDepartment of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Nguyen H TranDepartment of Oncology, Mayo Clinic, Rochester, MN, USA.
Sudhakar K VenkateshAbdominal Imaging Division, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Andreas TeufelDivision of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Matthias EbertClinical Cooperation Unit Healthy Metabolism Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Enrico N De ToniDepartment of Medicine II, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.
Dirk-Thomas WaldschmidtDepartment of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany.
Jens U MarquardtDepartment of Internal Medicine 1, University Hospital Schleswig-Holstein, Lübeck, Germany.
Dominik BettingerDepartment of Medicine II, Medical Center University of Freiburg, Freiburg, Germany.
Markus Peck-RadosavljevicDepartment of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Worthersee, Klagenfurt, Kärnten, Austria.
Andreas GeierDivision of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany.
Florian P ReiterDivision of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany.
Lorenza RimassaDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy.
David J PinatoDepartment of Surgery & Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Christoph RoderburgClinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Thomas EttrichDepartment of Internal Medicine I, University of Ulm, Ulm, Germany.
Michael BitzerDepartment of Internal Medicine 1, Division for Gastroenterology, Hepatology, Infectiology, Gastrointestinal Oncology and Geriatrics, University Hospital of Tübingen, Tübingen, Germany.
Veit SchebleDepartment of Internal Medicine 1, Division for Gastroenterology, Hepatology, Infectiology, Gastrointestinal Oncology and Geriatrics, University Hospital of Tübingen, Tübingen, Germany.
Ursula EhmerClinical Department for Internal Medicine II, Department of Clinical Medicine, TUM School of Medicine and Health, University Medical Center, Technical University of Munich, Germany.
Marie-Luise BerresMedical Department III, University Hospital RWTH Aachen, Aachen, Germany.
Fabian FinkelmeierMedical Clinic 1, University Hospital, Goethe-University Frankfurt, Frankfurt am Main, Germany.
Maria Angeles Gonzalez-CarmonaDepartment I of Internal Medicine, University Hospital of Bonn, Bonn, Germany.
Johann von FeldenI. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Kornelius SchulzeI. Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Marino VeneritoDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke University Hospital, Magdeburg, Germany.
Florian van BömmelDepartment of Medicine II, Division of Hepatology, Leipzig University Medical Center, Leipzig, Germany.
Leonie S JochheimDepartment of Gastroenterology and Hepatology, Essen University Hospital, Essen, Germany.
Matthias PinterDivision of Gastroenterology & Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Raphael MohrDepartment of Hepatology and Gastroenterology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
Sumera I IlyasDivision of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, USA.
Irene SchmidtmannInstitute of Medical Biometry, Epidemiology and Informatics of the Johannes Gutenberg University Mainz, Mainz, Germany.
Friedrich FoersterDepartment of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

Funding

Magnetic Resonance ElastographyR01EB001981 · NIBIB · MAYO CLINIC ROCHESTER · PI EHMAN, RICHARD L. · 2003 to 2013
$3.1M
Working to Eliminate Care Disparities in Liver Cancer in Southeast Asian Americans: Transportation and Other Social Determinants of Health.K23MD017217 · NIMHD · MAYO CLINIC ROCHESTER · PI Nguyen H Tran · 2022 to 2026
$818k
NIBIB NIH HHS R01 EB001981NIMHD NIH HHS K23 MD017217Wellcome Trust
6 · The paper itself

Abstract

Background & Aims: Immunotherapy with atezolizumab and bevacizumab (a + b) has improved the prognosis of patients with unresectable hepatocellular carcinoma (HCC). However, the outcome for individual patients is highly variable. This study aimed to (i) develop and validate a prognostic prediction model to estimate individual prognosis and (ii) compare it with established models. Methods: In this multicenter retrospective study, patients with HCC undergoing first-line immunotherapy with a + b from 24 centers (Europe, USA) were included. Statistical analysis and reporting followed the TRIPOD guidelines. The primary objective was overall survival (OS). A Cox model was developed and externally validated. Results: In total, 683 patients were included (training: 526, validation: 157). The C-reactive protein, albumin, bilirubin, lymphocytes, ECOG performance status, and extrahepatic spread (CABLE score) remained significantly associated with OS in Cox regression analysis. In the training set, the CABLE score had a higher discriminatory accuracy relative to ALBI, EZ-ALBI, mALBI, CRAFITY, PNI, NLR, PLR, and GPS (time-dependent AUC 0.79 and C-index 0.75 (95% CI 0.71-0.78) at 12 months). In the external validation set, the discriminatory performance of the CABLE score was comparable to ALBI, EZ-ALBI, and mALBI, but on average higher than PNI, CRAFITY, NLR, PLR, and GPS. In patients with Child-Pugh A, the CABLE score outperformed ALBI, EZ-ALBI, and mALBI in the first 9 months. We provide a web-based calculator for the CABLE score to allow estimation of individual prognosis for these patients (http://shiny.imbei.uni-mainz.de:3838/CABLE_Score/). Conclusions: The CABLE score shows good discriminatory performance in assessing the individual prognosis of patients undergoing first-line immunotherapy with a + b. Further validation studies are needed to investigate its performance compared with the ALBI score, in particular in subgroup analysis. Impact and implications: The CABLE score allows estimation of the prognosis of patients with unresectable hepatocellular carcinoma undergoing first-line immunotherapy with atezolizumab and bevacizumab at an individual level using our web-based calculator. This feature, as well as the evaluation of the score's added benefit through an extensive comparison with other established scores, can inform clinicians on their significance and may guide clinical decision-making in the context of a malignant disease where the prognosis has become highly variable. Further large validation studies are needed to investigate the incremental value of the CABLE score compared with the ALBI score, in particular in subgroups such as patients designated as Child-Pugh A.

Indexed as

CABLE scoreCirrhosisDevelopmentHepatocellular carcinomaImmune checkpoint inhibitorsImmunotherapyOutcomePD-L1Prediction modelSystemic therapyValidationVEGF

Identifiers

PMID40059970
PMCPMC11889551

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