Correlation Of Peripheral Blood Parameters On The Prognosis And Curative Effect Of Advanced Hepatocellular Carcinoma Treated With Immune Check-point Inhibitors

Background:Hepatocellular Carcinoma(HCC)is a kind of extremely dangerous malignant tumor which is common globally.It has been the third leading cause of cancer deaths in the world.Hepatocellular carcinoma is the main type of liver cancer,accouts for 75-85%and more.Early diagnosis is difficult for HCC,most of which are discovered in middle or late stage of the disease.Novel treatment of immunotherapy such as Immune Check-point Inhibitors(ICIs)would be a potential remedy for patients wih advanced HCC.However,the response rate of immunotherapy for solid tumors is unsatisfactory,and only some patients benefit from it.At present,accurate,sensitive and convenient biomarkers to evaluate the prognosis of immunotherapy have not been accessible.Objective:This study aims to explore the association between neutrophil to Neutrophil-to-Lymphocytefato ratio(NLR),Platelet-to-Lymphocyte ratio(PLR)prognostic nutritional index(PNI),systemic inflammatory response index(SIRI)and other indicators and the efficacy and prognosis of patients before immunotherapy in HCC patients.The purpose of this study is to provide reference for the selection of the population who might be benefited from ICIs and thus provide guidance for the precision immunotherapy of advanced Hepatocellular Carcinoma.Methods:We retrospectively collected the medical data and related indexes of patients receiving immunotherapy with advanced HCC in NanFang Hospital from July 2020 to November 2021,and explored the clinical guidance significance and value of related indexes in the assessment of efficacy and prognosis in HCC patients with Kaplan-Meier method,univariate and multivariate COX regression survival analysis.Results:1、This study included 157 patients.At the end of the follow-up,the curative effect analysis of four cycles revealed that 0 patient achieved CR,43 patients achieved PR,56 patients achieved SD and 58 patients achieved PD.The ORR was 27.4%.In our 157 patients treated with immunotherapy,overall median OS and overall PFS were 10.1 and 4.0 months,respectively.2、Significant differences were observed in baseline clinicopathological characteristics between groups stratified by NLR,with NLR>3.46 reporting higher incidence of PVT(p<0.001)and more advanced BCLC stage(p=0.029).Patients with PLR≥245.6 report higher ECOG performance status(p=0.025)and higher incidence of PVT(p=0.004),while Patients with PNI<41.7 report higher ECOG performance status(p<0.001)and higher incidence of PVT(p=0.001).Patients with PNI<41.7 report higher ECOG performance status(p<0.001)and higher incidence of PVT(p=0.001).Patients stratified by SIRI varied significantly in ECOG performance status(p=0.040).3、This study analyed of the factors associated with ORR.Chi-square test showed that baseline Child-Pugh grade(P=0.013)and baseline NLR level(P=0.029)put significant effect on ORR.Multiple logistic analysis revealed that NLR<3.46 was associated with higher ORR(OR=3.647,95%CI:1.368-7.061 P=0.032).4、This study analyed of the factors associated with PFS and OS.Univariate analysis indicated that patients with NLR≥3.46,PLR≥245.6,PNI<41.7,SIRI≥1.41 and portal vein thrombosis before treatment were associated with worse PFS,While patients with NLR≥3.46,PNI<41.7,SIRI≥1.41,portal vein thrombosis and Child-Pugh B grade before treatment had poorer OS.Mutiple analysis demonstrated that NLR≥3.46,PNI<41.7 and SIRI≥1.41 would possibly be the independent influential facter of PFS and higher risk of tumor progression.Independent prognostic factors of OS was NLR≥3.46,PNI<41.7,SIRI≥1.41 and Child-Pugh B grade.Conclusion:In patients with with advanced HCC who received immunotherapy,baseline level of higher NLR、PLR and SIRI and lower PNI was correlated with reduced OS and PFS.This indicator might contribute to may predict the efficacy of immunotherapy.