Predictive value of tumor burden and inflammatory indicators on the prognosis of ad-vanced hepatocellular carcinoma treated by triple therapy
Objective To explore the predictive value of pre-treatment tumor burden and inflammatory indicators on the prognosis of advanced hepatocellular carcinoma(HCC)patients receiving transcatheter arterial chemoembolization(TACE),tyrosine kinase inhibitors(TKI)and immune checkpoint inhibitors(ICIs),and to establish a model to predict the prognosis of patients.Methods The clinical data of 114 patients with advanced HCC were collected who received TACE,TKI combined ICIs in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021.With progression-free surviv-al(PFS)as the main end point of the study,the patients'tumor burden indicators,inflammation-related indicators and other general clinical indicators were included in univariate and multivariate COX regression analysis to screen out the independent prognostic factors of PFS.A new combined prognostic model was constructed based on screened independent predictors.Through Kaplan-Meier survival analysis and receiver operating characteristic(ROC)curve,the predictive value of the new model,single index and traditional staging method on the prognosis of patients were compared.Results Through univariate and multivariate COX analysis,the independent risk factors affecting the PFS of patients with advanced hepatocellular carcinoma re-ceiving TACE and TKI combined ICIs were tumor burden score(TBS)(cutoff value:7.96)(HR:3.421;95%CI:2.112-5.541;P<0.001)and neutrophil-to-lymphocyte ratio(NLR)(cutoff value:3.10)(HR:2.995;95%CI:1.860-4.821;P<0.001).The ROC curve showed that TBS and NLR had the best predictive effect on objective response rate(ORR),and the area under the curve(AUC)was 0.752(P<0.001)and 0.700(P<0.001),respectively.The overall median PFS was 9.0 months(95%CI:7.102-10.915).Kaplan-Meier analysis showed that patients with low TBS(≤7.96)had longer PFS than those with high TBS,and the median PFS was 13.0 months(95%CI:10.819-15.181)and 6.0 months(95%CI:4.492-7.508)(P<0.001).Compared with the high NLR group,the median PFS in the low NLR(≤3.10)group was longer[15.0 months(95%CI:11.426-18.574)and 7.5 months(95%CI:6.239-8.761);P<0.001].TBS-NLR prognosis model was built based on TBS in tumor burden index and NLR in inflammation index.The score of TBS≤7.96 and NLR≤3.10 was 0,and the score of TBS>7.96 and NLR>3.10 was 1.According to the total score of patients,they were divided into 0,1 and 2 groups,namely,high,medium and low sensitivity groups,and the median PFS had significant differences,which were 16.0 months(95%CI:12.359-19.641),9.0 months(95%CI:7.693-10.307)and 5.0 months(95%CI:2.600-7.400),respectively(P<0.001).ROC analysis showed that the TBS-NLR model was better than the single index of TBS and NLR in predicting ORR and disease control rate,AUC values were 0.819 and 0.803 respectively,and better than the china liver cancer staging.Conclusion TBS and NLR are independent predictors of prognosis in patients with intermediate and advanced HCC treated with TACE,TKI and ICIs.The TBS-NLR model based on thus has better prognosis prediction performance than single index,patients in the highly sensitive and intermediate-sensitive groups are more likely to have a survival benefit in TACE-TKI-ICIs,and can provide some help for the treatment of patients with advanced HCC.
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