血液生物标志物可预测接受免疫检查点抑制剂治疗的肝细胞癌患者的结局：44 项回顾性研究的汇总分析。
Blood biomarkers predict outcomes in patients with hepatocellular carcinoma treated with immune checkpoint Inhibitors: A pooled analysis of 44 retrospective sudies.
机构信息
Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Key Laboratory of Digestive System Disease, Wuhan, China.
Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Key Laboratory of Digestive System Disease, Wuhan, China.
出版信息
Int Immunopharmacol. 2023 May;118:110019. doi: 10.1016/j.intimp.2023.110019. Epub 2023 Mar 16.
OBJECTIVE
We conducted the first meta-analysis to identify the predictive significance of baseline blood biomarkers (such as neutrophil to lymphocyte ratio (NLR), early alpha-fetoprotein (AFP) response, albumin-bilirubin (ALBI), AFP, platelet to lymphocyte ratio (PLR), C-reactive protein (CRP), protein induced by vitamin K absence II (PIVKA-II), and lymphocyte to monocyte ratio (LMR)) in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs).
METHODS
Eligible articles were retrieved using PubMed, the Cochrane Library, EMBASE, and Google Scholar by November 24, 2022. Clinical outcomes were overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and hyperprogressive disease (HPD).
RESULTS
A total of 44 articles with 5322 patients were included in this meta-analysis. The pooled results demonstrated that patients with high NLR levels had significantly poorer OS (HR: 1.951, P < 0.001) and PFS (HR: 1.632, P < 0.001), lower ORR (OR: 0.484, P < 0.001) and DCR (OR: 0.494, P = 0.027), and higher HPD (OR: 8.190, P < 0.001). The patients with high AFP levels had shorter OS (HR: 1.689, P < 0.001) and PFS (HR: 1.380, P < 0.001), and lower DCR (OR: 0.440, P < 0.001) than those with low AFP levels, however, there was no difference in ORR (OR: 0.963, P = 0.933). We also found that early AFP response was correlated with better OS (HR: 0.422, P < 0.001) and PFS (HR: 0.385, P < 0.001), higher ORR (OR: 7.297, P < 0.001) and DCR (OR: 13.360, P < 0.001) compared to non-responders. Besides, a high ALBI grade was significantly related to shorter OS (HR: 2.440, P = 0.009) and PFS (HR: 1.373, P = 0.022), lower ORR (OR: 0.618, P = 0.032) and DCR (OR: 0.672, P = 0.049) than those with an ALBI grade 1.
CONCLUSION
The NLR, early AFP response, and ALBI were useful predictors of outcomes in HCC patients treated with ICIs.
目的
我们进行了首次荟萃分析，以确定基线血液生物标志物（如中性粒细胞与淋巴细胞比值（NLR）、早期甲胎蛋白（AFP）反应、白蛋白-胆红素（ALBI）、AFP、血小板与淋巴细胞比值（PLR）、C 反应蛋白（CRP）、维生素 K 缺乏诱导蛋白（PIVKA-II）和淋巴细胞与单核细胞比值（LMR））在接受免疫检查点抑制剂（ICI）治疗的肝细胞癌（HCC）患者中的预测意义。
方法
通过 PubMed、Cochrane 图书馆、EMBASE 和 Google Scholar 检索了截至 2022 年 11 月 24 日的合格文章。临床结局包括总生存期（OS）、无进展生存期（PFS）、客观缓解率（ORR）、疾病控制率（DCR）和超进展性疾病（HPD）。
结果
共纳入 44 篇文章，共计 5322 例患者。汇总结果表明，NLR 水平较高的患者 OS（HR：1.951，P<0.001）和 PFS（HR：1.632，P<0.001）更差，ORR（OR：0.484，P<0.001）和 DCR（OR：0.494，P=0.027）更低，HPD（OR：8.190，P<0.001）更高。AFP 水平较高的患者 OS（HR：1.689，P<0.001）和 PFS（HR：1.380，P<0.001）更短，DCR（OR：0.440，P<0.001）更低，而 AFP 水平较低的患者 ORR（OR：0.963，P=0.933）无差异。我们还发现早期 AFP 反应与更好的 OS（HR：0.422，P<0.001）和 PFS（HR：0.385，P<0.001）相关，更高的 ORR（OR：7.297，P<0.001）和 DCR（OR：13.360，P<0.001）相比无反应者。此外，较高的 ALBI 分级与较短的 OS（HR：2.440，P=0.009）和 PFS（HR：1.373，P=0.022）、较低的 ORR（OR：0.618，P=0.032）和 DCR（OR：0.672，P=0.049）相关，而 ALBI 分级为 1 的患者则相反。
结论
NLR、早期 AFP 反应和 ALBI 是接受 ICI 治疗的 HCC 患者结局的有用预测指标。
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