Müller Lukas, Gairing Simon Johannes, Kloeckner Roman, Foerster Friedrich, Weinmann Arndt, Mittler Jens, Stoehr Fabian, Emrich Tilman, Düber Christoph, Galle Peter Robert, Hahn Felix
Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
Cancers (Basel). 2022 Jul 22;14(15):3574. doi: 10.3390/cancers14153574.
: An association between immunotherapy and an increase in splenic volume (SV) has been described for various types of cancer. SV is also highly predictive of overall survival (OS) in patients with hepatocellular carcinoma (HCC). We evaluated SV and its changes with regard to their prognostic influence in patients with HCC undergoing immunotherapy. : All patients with HCC who received immunotherapy in first or subsequent lines at our tertiary care center between 2016 and 2021 were screened for eligibility. SV was assessed at baseline and follow-up using an AI-based tool for spleen segmentation. Patients were dichotomized into high and low SV based on the median value. : Fifty patients were included in the analysis. The median SV prior to treatment was 532 mL. The median OS of patients with high and low SV was 5.1 months and 18.1 months, respectively ( = 0.01). An increase in SV between treatment initiation and the first follow-up was observed in 28/37 (75.7%) patients with follow-up imaging available. This increase in itself was not prognostic for median OS (7.0 vs. 8.5 months, = 0.73). However, patients with high absolute SV at the first follow-up continued to have impaired survival (4.0 months vs. 30.7 months, = 0.004). : High SV prior to and during treatment was a significant prognostic factor for impaired outcome. Although a large proportion of patients showed an SV increase after the initiation of immunotherapy, this additional immuno-modulated SV change was negligible compared to long-standing changes in the splanchnic circulation in patients with HCC.
: 免疫疗法与多种癌症患者脾体积（SV）增加之间的关联已被描述。SV对肝细胞癌（HCC）患者的总生存期（OS）也具有高度预测性。我们评估了接受免疫疗法的HCC患者中SV及其变化对预后的影响。: 对2016年至2021年期间在我们三级医疗中心接受一线或后续免疫疗法的所有HCC患者进行了资格筛查。使用基于人工智能的脾脏分割工具在基线和随访时评估SV。根据中位数将患者分为高SV组和低SV组。: 50名患者纳入分析。治疗前SV的中位数为532 mL。高SV组和低SV组患者的中位OS分别为5.1个月和18.1个月（P = 0.01）。在有随访影像学资料的37例患者中，28例（75.7%）在治疗开始至首次随访期间出现SV增加。这种增加本身对中位OS无预后意义（7.0个月对8.5个月，P = 0.73）。然而，首次随访时绝对SV高的患者生存期仍较差（4.0个月对30.7个月，P = 0.004）。: 治疗前及治疗期间高SV是预后不良的重要预测因素。尽管很大一部分患者在免疫疗法开始后出现SV增加，但与HCC患者内脏循环的长期变化相比，这种额外的免疫调节性SV变化可忽略不计。
