| Hepatocellular carcinoma(HCC)is a common malignancy with a high incidence and increasing mortality rate worldwide.Transcatheter arterial chemoembolization(TACE)is the treatment of choice for patients with intermediate to advanced disease.However,TACE can lead to hypoxia in the tumour tissue and ultimately induce the secretion of cytokines such as vascular endothelial growth factor(VEGF),which can contribute to tumour angiogenesis and thus mediate tumour growth or metastasis.In addition,repeated TACE procedures gradually aggravate liver function damage and cirrhosis,so the benefits of TACE-only treatment are significantly limited,while the emergence of new anti-tumour drugs such as sorafenib and carrilizumab has provided new ideas for the combined treatment of TACE.The systemic inflammatory response,which can be assessed by inflammatory biomarkers,is a hotly researched inflammatory biomarker in recent years and can reflect the prognosis of HCC patients.It can help clinicians to better stratify patients and develop individual treatment plans,which can help improve the prognosis of patients PurposeTo investigate the correlation between systemic immune inflammatory index(SII)and prognosis in patients with intermediate to advanced hepatocellular carcinoma treated with TACE alone,TACE in combination with sorafenib and TACE in combination with carrilizumab and apatinib,and to calculate the optimal preoperative SII cut-off values for each procedure.MethodsClinical case data and follow-up data of patients with intermediate to advanced hepatocellular carcinoma treated with TACE alone,TACE combined with sorafenib and TACE combined with carrilizumab and apatinib were retrospectively collected from June 2019 to December 2021 at the Comprehensive Interventional Unit of Weihai Central Hospital.A total of 135 patients were included in this study according to the inclusion and exclusion criteria.Of these,45 patients were treated with TACE alone,45 patients were treated with TACE in combination with sorafenib and 45 patients were treated with TACE in combination with carrilizumab and apatinib.The difference in overall survival(OS)was compared between the groups.The receiver operating characteristic curve(ROC)and area under curve(AUC)were used to assess the predictive ability of the SII for the outcome of patients with intermediate to advanced HCC after treatment with different treatment modalities.Results1.ROC analysis showed that the best critical value of SII was 367 for patients in the TACE-only group,29 patients with SII≤367 and 16 patients with SII>367,which corresponded to an area under the curve of 0.751 and a sensitivity of 48.3%.The mean OS time was 11.1 months for patients with preoperative SII≤367,which was significantly longer than that of 5.8 months for preoperative>367,with a statistically significant difference(P<0.05);univariate analysis showed that pre-treatment SII>367(P<0.01),presence of cirrhosis(P<0.05)and BCLC stage(P<0.05)were correlated with postoperative OS(P< 0.05).Multifactorial analysis showed that preoperative SII,cirrhosis,and BCLC stage were significant independent influences on OS(P<0.05)2.ROC analysis showed that the best critical value of SII for patients in the sorafenib combination group was 317,with 23 patients with SII ≤ 317 and 22 patients with SII > 317,which corresponded to an area under the curve of 0.751 and a sensitivity of 71.9%.The mean OS time was 16.2 months for patients with preoperative SII≤317,significantly longer than 11.8 months for those with preoperative >317,with a statistically significant difference(P<0.05);SII>317(P<0.05),tumour size(P<0.05)and BCLC stage(P<0.05)before combination therapy were correlated with postoperative OS(P<0.05).Multi-factor analysis showed that preoperative SII,tumour size,and BCLC stage were significant independent influencing factors for OS(P<0.05)3.ROC analysis showed that the best critical value of SII was 343 for patients in the kareolizumab combination group,with 28 patients with SII≤343 and 17 patients with SII>343,which corresponded to an area under the curve of 0.660 and a sensitivity of43.8%.The mean OS time for patients with hepatocellular carcinoma with preoperative SII≤343 was 17.8 months,which was significantly longer than that of 13.4 months for preoperative SII>343,with a statistically significant difference(P<0.05);univariate analysis showed that SII>343(P<0.05)and BCLC stage(P<0.05)before combination therapy were correlated with postoperative OS(P<0.05).Multi-factor analysis showed that preoperative SII and BCLC stage were significant independent influencing factors for OS(P<0.05).4.Patients in the sorafenib combination group had a mean OS of 13.5 months and a median OS of 14 months,while patients in the TACE alone group had a mean OS of 9.5months and a median OS of 9 months.patients in the TACE combined with sorafenib group had a significantly higher OS than those in the TACE alone group(P<0.05);the median TTP was also longer in the sorafenib combination group than in the TACE alone group(11 months vs.8 months,P<0.001),as detailed in Figure 8 and Table 12.5.Patients in the carrilizumab combination group had a mean OS of 16.7 months and a median OS of 17 months,while patients in the sorafenib combination group had a mean OS of 13.5 months and a median OS of 14 months.Patients in the carrilizumab combination group had a higher OS than those in the sorafenib combination group(P<0.001),and the median TTP was also longer in the carrilizumab combination group than in the sorafenib combination group(13 months vs 11 months,P<0.001)Conclusions1.The existence of optimal threshold values for preoperative systemic immunoinflammatory indices for various treatment modalities enables prediction of outcomes for patients with intermediate to advanced hepatocellular carcinoma,and provides a reference for the choice of treatment modality for patients with intermediate to advanced hepatocellular carcinoma.2.Survival was significantly improved with TACE combined with targeted and immunologic agents compared with TACE alone. |
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