Mei Jie, Sun Xu-Qi, Lin Wen-Ping, Li Shao-Hua, Lu Liang-He, Zou Jing-Wen, Wei Wei, Guo Rong-Ping
Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
J Inflamm Res. 2021 Aug 11;14:3879-3890. doi: 10.2147/JIR.S325600. eCollection 2021.
Inflammatory response is related to cancer progression and patient survival. However, the value in predicting survival in hepatocellular carcinoma (HCC) patients who received anti-PD-1 therapy has not been elucidated. This study aimed to compare the predictive ability of inflammation-based scores for the prognosis of HCC patients after anti-PD-1 therapy.
A total of 442 patients who received anti-PD-1 therapy were included in the study. Representative inflammation-based prognostic scores, including the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-C-reactive protein (CRP) ratio (LCR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SII), CRP-to-albumin ratio (CAR), prognostic nutritional index (PNI), Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), and prognostic index (PI), were assessed for prediction accuracy using Kaplan-Meier survival curves, time-dependent receiver operating characteristic (ROC) and Harrell's concordance index (C-index) analyses.
All the inflammation-based prognostic scores exhibited good discriminatory ability in overall survival (OS) (all P < 0.01), while the PNI score was a unique independent predictor for OS in multivariate analysis (hazard ratio, 1.770; confidence interval, 1.309-2.393; P < 0.001). The areas under the ROC curves at 6, 12, 18 and 24 months and the C-index (0.65) demonstrated that the predictive accuracy of the PNI score was superior to that of the other inflammation-based scores.
The PNI score is a discriminatory prognostic indicator for OS in HCC patients with anti-PD-1 therapy and is superior to the other inflammation-based prognostic scores in terms of predictive ability.
炎症反应与癌症进展及患者生存相关。然而，抗程序性死亡蛋白1（PD-1）治疗的肝细胞癌（HCC）患者中炎症指标对生存的预测价值尚未阐明。本研究旨在比较基于炎症的评分对HCC患者抗PD-1治疗后预后的预测能力。
本研究共纳入442例接受抗PD-1治疗的患者。采用Kaplan-Meier生存曲线、时间依赖性受试者工作特征（ROC）曲线及Harrell一致性指数（C指数）分析，评估包括血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）、淋巴细胞与C反应蛋白（CRP）比值（LCR）、淋巴细胞与单核细胞比值（LMR）、全身免疫炎症指数（SII）、CRP与白蛋白比值（CAR）、预后营养指数（PNI）、格拉斯哥预后评分（GPS）、改良格拉斯哥预后评分（mGPS）及预后指数（PI）等具有代表性的基于炎症的预后评分的预测准确性。
所有基于炎症的预后评分在总生存期（OS）方面均表现出良好的鉴别能力（均P<0.01），而PNI评分在多因素分析中是OS的唯一独立预测因素（风险比，1.770；置信区间，1.309 - 2.393；P<0.001）。ROC曲线在6、12、18和24个月时的曲线下面积及C指数（0.65）表明，PNI评分的预测准确性优于其他基于炎症的评分。
PNI评分是接受抗PD-1治疗的HCC患者OS的鉴别预后指标，且在预测能力方面优于其他基于炎症的预后评分。
