The PLANES model for unresectable hepatocellular carcinoma treated with transcatheter arterial chemoembolization plus lenvatinib and PD-1 inhibitors: a multicenter, retrospective study

Background: The triple therapy regimen of transcatheter arterial chemoembolization (TACE) plus lenvatinib and PD-1 inhibitors plays a significant role in the treatment of unresectable hepatocellular carcinoma (uHCC). However, only a subset of patients can benefit from it, making it crucial to screen for those who may benefit from the triple therapy regimen. This study constructed and assessed a survival prediction nomogram for uHCC patients undergoing first-line triple therapy. Methods: Using retrospective data from 277 consecutive triple-therapy patients (treated at six Chinese centers between 2018-2023), we constructed the nomogram based on multivariate-derived predictors. Model performance was quantified through discrimination metrics and bootstrapped internal validation. External validation employed an independent cohort (n=208) from three additional institutions. Results: Independent predictors of overall survival (OS) included alpha-fetoprotein (AFP), maximum tumor diameter, tumor number, extrahepatic metastasis, and platelet-to-lymphocyte ratio (PLR). A PLANES model was constructed to predict 12-, 24-, and 36-month OS. The model demonstrated robust discriminative performance, with area under the curve (AUC) values of 0.887, 0.793 and 0.749 for 12-, 24-, and 36-month OS in the training cohort, respectively. External validation yielded AUCs of 0.922, 0.760, and 0.722 for corresponding time points. Conclusions: The PLANES model was successfully established and validated for predict prognosis in unresectable HCC patients receiving first-line triple therapy.