| Objective:Uric acid plays the dual role of antioxidant and pro-oxidant in patients with malignancy,and the relationship between serum uric acid and malignancy is not clear,thus requiring further elucidation.This study aimed to investigate the prognostic value of serum uric acid concentration on the efficacy ofimmunotherapy inprimary livercancer patients.Methods:Aretrospective study collected 2342 patients diagnosed with primary liver cancer admitted to the First Affiliated Hospital of Gannan Medical College from January 2019 to June 2022.Enrollment patients were strictly screened according to inclusion and exclusion criteria,and patients who failed screening were not included in any analysis.Finally,99 patients were enrolled in this study cohort.None of the enrolled patients had any family history.Serum uric acid levels of patients were measured before receiving immunotherapy,and data on demographics,clinical characteristics,and laboratory tests were collected to record their histological or imaging characteristics.The differences between serum uric acid levels in primary liver cancer patients and the healthy population were analyzed by t-test.The optimal cut and area under the curve of uric acid before immunotherapy was determined according to the Youden index by drawing the receiver working curve.Patients were divided into high serum uric acid and low serum uric acid groups,and the correlation between serum uric acid levels and clinical characteristics of patients with primary liver cancer were analyzed by chi-square test.The primary study endpoint of this study was overall survival(OS).Survival was estimated by the Kaplan-Meier method,survival plots were drawn,and the overall 95% confidence interval of the median time was calculated using the Brookmeyer Crowley method.The univariate analysis of OS was performed by using the Log-rank test.Amultivariate Cox proportional hazards regression model was used to assess independent risk factors for OS.Results:Ninety-nine patients with primary liver cancer diagnosis were included in this study cohort.The median follow-up period was 7 months(range 1-29 months),and a total of 76(76.8%)of 99 primary liver cancer patients died as of 31 December2022.Among them,86 were malepatients and 13 female patients;26-84 years,mean age 57.79 ± 7.79 years;92 hepatocellular carcinoma and 7cholangiocellular carcinoma.According to the stage of liver cancer in China,liver cancer patients were divided into four stages: 7 stage I,9 stage II,77 stage III and 6 stage IV,with immunotherapy averaged 3 times.Serum uric acid concentrations ranged from 105μmol/l–670μmol/l,with a median value of 269μmol/l.The results showed that the serum uric acid level of liver cancer patients was higher than that of normal healthy people(P <0.001).After the gender subgroup analysis,the uric acid level of male liver cancer patients was higher than that of normal healthy men(P=0.001),while no association was found in women(P> 0.05).Among the clinical parameters,uric acid levels were associated with body mass index(P=0.012)and Child grade(P=0.006).The Kaplan-Meier analysis showed that higher uric acid levels were associated with worse overall survival(P = 0.005).In univariate analysis,the overall survival rate of patients with elevated uric acid levels was significantly lower(HR 3.191,95% CI 1.456-6.993,P=0.004),with a median survival time of 151 days in the high serum uric acid group and 312 days in the low serum uric acid group,and the accumulation of serum uric acid in vivo may lead to tumor progression and shortened patient survival.In the multivariate analysis,found that the uric acid level was an independent prognostic factor for the prediction of patient mortality(HR 3.131,95% CI 1.766-5.553,P<0.001),but not enough to predict tumor stage,vascular invasion,portal hypertension and distant metastasis.Besides,number of immunotherapy drugs(HR 0.543,95% CI 0.325-0.907,P=0.02)and the Child classification(HR 1.617,95% CI1.110-2.354,P=0.012)was also an independent prognostic factor for OS in immunotherapy patients with primary liver cancer.Conclusion:The serum uric acid level of liver cancer patients was higher than that of normal healthy people.However,after gender subgroup analysis,it was only found that the uric acid level of male liver cancer patients was higher than that ofnormal healthy men,while no correlation was found in women.Among the clinical parameters,uric acid levels were correlated with body mass index(BMI)and Child grade.Patients with elevated uric acid levels had significantly lower overall survival,with a median survival time of 151 days in the high serum uric acid group and 312 days in the low serum uric acid group,and the accumulation of serum uric acid in vivo may contribute to tumor progression and shortened patient survival.In multivariate analysis,found that serum uric acid level is the independent prognostic factors of immunotherapy of primary liver cancer,but not enough to predict tumor stage,vascular invasion,portal hypertension and distant metastasis.In addition,the number of immunotherapy medication and Child grade is also the independent prognostic factors of OS in patients with primary liver cancer immunotherapy.Therefore,the serum uric acid level is a reliable biomarkerforpredicting theprognosis of patients undergoing immunotherapy forprimary livercancer.It is suggested to dynamically monitor serum uric acid levels to make up for the deficiency of the prognosis of liver cancer by the currentliver cancer staging system. |
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