Evaluation of the Prognostic Importance of Gustave Roussy Immune Score in Hepatocellular Cancer Etiological Subtypes

Year 2025, Volume: 16 Issue: 4, 570 - 575, 01.01.2026

İlknur Deliktaş Onur , Hatice Gülgün Fırat , Alper Türkel , Elif Sertesen Çamöz , Necla Demir , Fatih Yıldız

https://doi.org/10.18663/tjcl.1810106

Abstract

Objective: The prognostic efficiencies of GRIm and HCC-GRIm scores in HCC have been determined in previous studies. However, there is no study evaluating them according to etiological subtypes in the literature yet. The aim of this study was to investigate the prognostic efficacy of GRIm (Gustave Roussy immune score) and HCC-GRIm score in HCC etiological subgroups.
Methodology: The study was conducted on patients aged 18 years and older with unresectable/metastatic hepatocellular cancer (HCC) diagnosed between 2017 and 2023. GRIm and HCC-GRIm scores was calculated. The prognostic efficiencies of these scores were evaluated.
Results: Sixty-seven (54%) of the patients had low GRIm scores, while 68(54.8%) had low HCC-GRIm scores. Median overall survival (OS) was 17.2 months in patients with low-viral GRIm scores, while median OS was 2.1 months in patients with high-viral GRIm scores. Median OS was 12.6 months in patients with low-nonviral GRIm scores. Median OS was 3.3 months in patients with high-nonviral GRIm scores (HR: 2.4(%95 CI 1.3-4.7) p<0.001).
Conclusion: We found that GRIm score was prognostic in terms of OS in HCC. GRIm scores were higher in patients with viral etiology. However, when we evaluated the patients with low/high GRIM scores in terms of viral etiology/nonviral etiology, there was no significant difference in OS. We believe that the GRIm score may help clinicians in terms of prognosis in a difficult-to-manage disease such as HCC. Larger-scale studies investigating prognosis and treatment efficacies in etiological subtypes of HCC are needed.

Keywords

HCC-GRIm score , GRIm score , HCC , HCC etiology , HCC prognostic score

Ethical Statement

All authors declare that they have no conflict of interest.

Supporting Institution

There is no supporting institution.

Hepatoselüler Kanser Etiyolojik Subtiplerinde Gustave Roussy İmmün Skorunun Prognostik Öneminin Değerlendirilmesi

Abstract

Amaç: HCC'de GRIm ve HCC-GRIm skorlarının prognostik etkinlikleri çalışmalarla belirlenmiştir. Ancak literatürde henüz etiyolojik alt tiplere göre değerlendiren bir çalışma bulunmamaktadır. Bu çalışmanın amacı, HCC etiyolojik alt gruplarında GRIm (Gustave Roussy immün skoru) ve HCC-GRIm skorunun prognostik etkinliğini araştırmaktır.
Metodoloji: Çalışmaya, 2017-2023 yılları arasında tanı almış, rezeke edilemeyen/metastatik hepatoselüler kanserli (HCC) 18 yaş ve üzeri hastaları dahil edilmiştir. Hastaların tanı anındaki GRIm ve HCC-GRIm skorları hesaplanmış ve bu skorların prognostik etkinlikleri değerlendirilmiştir.
Sonuçlar: Hastaların 67'sinde (%54) düşük GRIm skoru, 68'inde (%54,8) ise düşük HCC-GRIm skoru saptandı. Düşük GRIm skorlu viral etyolojili hastalarda ortanca genel sağkalım (OS) 17,2 ay iken, yüksek GRIm skorlu viral etyolojili hastalarda ortanca OS 2,1 ay olarak bulundu. Düşük GRIm skorlu nonviral etyolojili hastalarda ortanca OS 12,6 ay olarak bulundu. Yüksek GRIm skorlu nonviral hastalarda ortanca OS 3,3 ay olarak bulundu (HR: 2,4 (%95 CI 1,3-4,7) p<0,001).
Sonuç: HCC'de GRIm skorunun OS açısından prognostik olduğunu bulduk. Viral etiyolojili hastalarda GRIm skorları daha yüksekti. Ancak düşük/yüksek GRIM skorlu hastaları viral etyoloji/viral olmayan etyoloji açısından değerlendirdiğimizde OS'de anlamlı bir fark bulunamadı. GRIm skorunun HCC gibi yönetimi zor bir hastalıkta prognoz açısından klinisyenlere yardımcı olabileceğine inanıyoruz. HCC’nin etiyolojik alt tiplerinde prognoz ve tedavi etkinliğini araştıran daha geniş ölçekli çalışmalara ihtiyaç vardır.

Keywords

HCC-Grım skoru , GRIm skoru , HCC , HCC etyolojisi , HCC prognostik skor

Ethical Statement

Tüm yazarlar çıkar çatışması olmadığını beyan eder.

Supporting Institution

Destekleyen kurum yoktur.

References

• Akinyemiju T, Abera S, Ahmed M, Alam N, Ames MA, Barac A et al. The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level: Results From the Global Burden of Disease Study 2015. JAMA Oncol 2017; 3: 1683-91.
• Torimura T, Iwamoto H. Treatment and the prognosis of hepatocellular carcinoma in Asia. Liver Int 2022; 42: 2042-54.
• Gordan JD, Kennedy EB, Abou-Alfa GK, Begms MS, Brower ST, Gade TP et al. Systemic Therapy for Advanced Hepatocellular Carcinoma: ASCO Guideline. J Clin Oncol 2020; 38: 4317-45.
• Reiss KA, Yu S, Mamtani R, Mehta R, D'Addeo K, Wileyto EP et al. Starting dose of sorafenib for the treatment of hepatocellular carcinoma: a retrospective, multi-institutional study. J Clin Oncol 2017; 35: 3575-81.
• Finn RS, Qin S, Ikeda M, Galle PR, Ducreux M, Kim TY et al. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med 2020; 382: 1894-1905.
• Abou-Alfa GK, Lau G, Kudo M, Chan SL, Kelley RK, Furuse J et al. Tremelimumab plus durvalumab in unresectable hepatocellular carcinoma. NEJM Evid 2022; 1: EVIDoa2100070.
• Bigot F, Castanon E, Baldini C, Hollebecque A, Carmona A, Postel-Vinay S et al. Prospective validation of a prognostic score for patients in immunotherapy phase I trials: The Gustave Roussy Immune Score (GRIm-Score). Eur J Cancer 2017; 84: 212-18.
• Sun KX, Xu R, Bing ZC, Lu J, Li YY, Wang J et al. Prognostic significance of the Gustave Roussy immune (GRIm) score in cancer patients: a meta-analysis. Ann Med 2023; 55: 2236640.
• Li Y, Pan Y, Lin X, Wei X, He B, Zhou J et al. Development and validation of a prognostic score for hepatocellular carcinoma patients in immune checkpoint inhibitors therapies: the hepatocellular carcinoma modified Gustave Roussy immune score. Front Pharmacol 2022; 12: 819985.
• Li SJ, Zhao L, Wang HY, Han JL, Han J, Liu HC et al. Gustave Roussy immune score based on a three-category risk assessment scale serves as a novel and effective prognostic indicator for surgically resectable early-stage non-small-cell lung cancer: A propensity score matching retrospective cohort study. Int J Surg 2020; 84: 25-40.
• Feng JF, Wang L, Yang X, Huang Y. Gustave Roussy Immune Score (GRIm-Score) is a prognostic marker in patients with resectable esophageal squamous cell carcinoma. J Cancer 2020; 11: 1334-40.
• Shi Y, Ju M, Di X, Wang Z. Prognostic value of modified-Gustave-Roussy Immunity Score in resectable proximal gastric cancer. Medicine (Baltimore) 2023; 102: e33334.
• Basoglu T, Babacan NA, Ozturk FE, Aksoy A, Arpaci E, Erdemli S et al. Prognostic value of Gustave Roussy immune score in operable pancreatic adenocarcinoma. Indian J Cancer 2023; DOI:10.4103/ijc.IJC_1049_20.
• Guo Y, Lan Q, Li J, Zhu X, Tang W. Association between ascites Gustave Roussy immune score and the intratumoural microbiome in malignant ascites secondary to hepatocellular carcinoma. Int Immunopharmacol 2024; 133: 112097.
• Finn RS, Ryoo BY, Merle P, Kudo M, Bouattour M, Lim HY et al. Pembrolizumab as second-line therapy in patients with advanced hepatocellular carcinoma in KEYNOTE-240: a randomized, double-blind, phase III trial. J Clin Oncol 2020; 38: 193-202.
• Yau T, Park JW, Finn RS, Cheng AL, Mathurin P, Edeline J et al. CheckMate 459: A randomized, multi-center phase III study of nivolumab (NIVO) vs sorafenib (SOR) as first-line (1L) treatment in patients (pts) with advanced hepatocellular carcinoma (aHCC). Ann Oncol 2019; 30: v874-75.
• Pfister D, Núñez NG, Pinyol R, Govaere O, Pinter M, Szydlowska M et al. NASH limits anti-tumour surveillance in immunotherapy-treated HCC. Nature 2021; 592: 450-56.
• Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK et al. AJCC cancer staging manual. 8th ed. New York: Springer; 2017.
• Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985; 56: 918-28.
• Llovet JM, Bruix J. Prospective validation of the Cancer of the Liver Italian Program (CLIP) score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatology 2000; 32: 679-80.
• Marrero JA, Fontana RJ, Barrat A, Askari F, Conjeevaram HS, Su GL et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 2005; 41: 707-16.
• Albers I, Hartmann H, Bircher J, Creutzfeldt W. Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis. Scand J Gastroenterol 1989; 24: 269-76.