A RECENT Japanese study successfully validated the utility of the CLEAR score, a straightforward prognostic tool designed to predict outcomes for patients with hepatocellular carcinoma (HCC) who are undergoing combined atezolizumab and bevacizumab (Atez/Bev) therapy. As this dual regimen becomes standard care, a simple method for risk stratification is highly valuable in oncology, allowing clinicians to manage patient expectations, tailor subsequent treatment strategies, and potentially improve long-term survival for those with this common form of liver cancer.
Blood Markers Predict Hepatocellular Carcinoma Outcomes
The comprehensive study enrolled 498 Japanese HCC patients receiving the Atez/Bev combination therapy between 2020 and 2023. This large cohort was ethically divided into a training set and a validation set across 24 different hospitals, strengthening the reliability of the findings. The researchers first analysed prognostic factors in the training set, leading to the development and subsequent evaluation of the new CLEAR score.
Multivariate analysis zeroed in on two critical and easily accessible blood markers as independent prognostic factors for poor outcomes: serum lactate dehydrogenase (LDH) levels exceeding the upper normal limit and C-reactive protein (CRP) levels of 0.50 mg/dL or higher. These two inflammatory markers formed the entire basis of the CLEAR score, which assigns 0, 1, or 2 points based on the presence of these poor prognostic factors.
The results demonstrated a clear and statistically significant distinction between the groups. In the training set, the median progression-free survival (PFS) was 11.1 months for patients with a score of 0, dropping sharply to just 3.3 months for a score of 2. Crucially, these trends were observed for overall survival (OS) as well and were successfully reproduced in the separate validation set. For this validation group, overall survival dropped from 30.6 months (score 0) to a difficult 8.9 months (score 2). The simplicity and high discriminative power of the CLEAR score make it a valuable clinical tool for predicting the prognosis of hepatocellular carcinoma patients on this increasingly common dual therapy regimen.
Reference
Tanaka K et al. Clinical utility of a prognostic scoring system based on LDH and CRP in HCC patients receiving atezolizumab plus bevacizumab. Liver Int. 2025;45(10):e70286.
