Department of General Surgery, Chengdu Public Health Clinical Medical Center, Sichuan Province, Chengdu, China.
Department of Liver Surgery and Liver transplantation Laboratory, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China.
BMC Cancer. 2022 Mar 23;22(1):311. doi: 10.1186/s12885-022-09433-3.
Immunotherapy has become a new therapy for advanced hepatocellular carcinoma (HCC); however, its treatment results are considerably different. CD4+ T cells (CD4+) are the key to immunotherapy, but patients with HCC that have low CD4+ are rarely observed for clinical evidence. Hepatitis B virus-related HCC is often accompanied by cirrhosis and portal hypertension; therefore, CD4+ tend to be relatively low in number. TACE is the standard treatment for Barcelona Clinic Liver Cancer (BCLC)-B HCC, which may further reduce the number of CD4 + .
This retrospective cohort study further reduced CD4+ by including patients with human immunodeficiency virus (HIV) to observe the relationship between CD4+ and Chronic hepatitis B virus (CHB) induced HCC. A total of 170 BCLC-B HCC patients (42 HIV+) were included. Univariate and multivariate analyses, and artificial neural networks (ANNs) were used to evaluate the independent risk factors for the two-year survival.
The statistical analysis of the two-year survival rate showed that the main factors influencing survival were liver function and immune indices, including CD4+, platelet, alanine aminotransferase, aspartate aminotransferase, aspartate aminotransferase-to-platelet ratio index, and fibrosis-4 (FIB-4) (P < 0.05). Compared with that in other indices, in logistic and ANN multivariate analysis, CD4 + -to-FIB-4 ratio (CD4+/FIB-4) had the highest importance with 0.716 C-statistic and 145.93 cut-off value. In terms of overall survival rate, HIV infection was not a risk factor (P = 0.589); however, CD4+/FIB-4 ≤ 145.93 significantly affected patient prognosis (P = 0.002).
HIV infection does not affect the prognosis of BCLC-B HCC, but CD4+ have a significant predictive value. CD4+ played a vital role in HCC and this deserves the attention from physicians. Further, the CD4+/FIB-4 is a clinically valuable effective prognostic indicator for these patients.
免疫疗法已成为治疗晚期肝细胞癌（HCC）的新疗法；然而，其治疗效果差异很大。CD4+T 细胞（CD4+）是免疫治疗的关键，但很少有临床证据表明 HCC 患者的 CD4+较低。乙型肝炎病毒相关 HCC 常伴有肝硬化和门静脉高压；因此，CD4+的数量往往相对较低。TACE 是巴塞罗那临床肝癌（BCLC）-B HCC 的标准治疗方法，这可能进一步降低 CD4+的数量。
本回顾性队列研究通过纳入人类免疫缺陷病毒（HIV）患者进一步降低 CD4+，观察 CD4+与慢性乙型肝炎病毒（CHB）诱导 HCC 之间的关系。共纳入 170 例 BCLC-B HCC 患者（42 例 HIV+）。采用单因素和多因素分析以及人工神经网络（ANNs）评估两年生存率的独立危险因素。
对两年生存率的统计分析表明，影响生存的主要因素是肝功能和免疫指标，包括 CD4+、血小板、丙氨酸转氨酶、天冬氨酸转氨酶、天冬氨酸转氨酶/血小板比值指数和纤维化 4（FIB-4）（P<0.05）。与其他指标相比，在逻辑和 ANN 多因素分析中，CD4+/FIB-4 比值（CD4+/FIB-4）的重要性最高，C 统计量为 0.716，截断值为 145.93。在总生存率方面，HIV 感染不是危险因素（P=0.589）；然而，CD4+/FIB-4≤145.93 显著影响患者预后（P=0.002）。
HIV 感染不影响 BCLC-B HCC 的预后，但 CD4+具有显著的预测价值。CD4+在 HCC 中起着至关重要的作用，这值得医生关注。此外，CD4+/FIB-4 是这些患者具有临床价值的有效预后指标。
