He Meiling, Liang Chunfeng, Pang Yadan, Jiang Mengjie, Long Meiying, Yao Zhongqiang, Wang Xiaoting, Zhang Ruijun, Wu Qiaoyuan, Liang Shixiong, Li Jianxu
Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530021, People's Republic of China.
School of Public Health, Guangxi Medical University, Nanning, 530021, People's Republic of China.
J Hepatocell Carcinoma. 2024 May 22;11:913-925. doi: 10.2147/JHC.S459683. eCollection 2024.
The combination of radiotherapy and monoclonal antibody against programmed cell death 1 (anti-PD1) showed preliminary efficacy in hepatocellular carcinoma (HCC). This study aimed to identify the prognostic factors and construct a nomogram to predict the overall survival (OS) of patients with advanced HCC after treatment with intensity-modulated radiotherapy (IMRT) plus anti-PD1.
The OS and progression-free survival (PFS) of 102 patients with BCLC stage C HCC was analyzed using the Kaplan-Meier method. Potential independent prognostic factors were determined using univariate and multivariate Cox regression analyses. A nomogram was established to predict prognosis whose accuracy and reliability was verified by a calibration curve and area under the receiver operating characteristic curve (AUROC).
The median PFS and OS rates of the 102 patients with advanced HCC were 9.9 months and 14.3 months, respectively. Ninety-three patients were evaluated for efficacy, including five (5.38%) with complete response and 48 (51.61%) with partial response, with an overall response rate of 56.99%. Grade 3 and 4 adverse reactions (AEs) were observed in 32.35% of patients; no grade 5 AEs occurred. Multivariate Cox analysis revealed albumin and alpha-fetoprotein levels, neutrophil counts 3-4 weeks after IMRT initiation, and platelet-to-lymphocyte ratio 3-4 weeks after IMRT initiation to be independent prognostic factors. The nomogram model constructed using these factors had good consistency and accuracy with 1-3 years AUROC of 78.7, 78.6, and 93.5, respectively.
IMRT plus anti-PD1 showed promising efficacy and controllable adverse reactions in treating advanced HCC. The nomogram model demonstrated good reliability and clinical applicability.
放射治疗与抗程序性细胞死亡蛋白1单克隆抗体（抗PD1）联合应用在肝细胞癌（HCC）中显示出初步疗效。本研究旨在确定预后因素并构建列线图，以预测接受调强放射治疗（IMRT）加抗PD1治疗的晚期HCC患者的总生存期（OS）。
采用Kaplan-Meier法分析102例BCLC C期HCC患者的OS和无进展生存期（PFS）。使用单因素和多因素Cox回归分析确定潜在的独立预后因素。建立列线图以预测预后，其准确性和可靠性通过校准曲线和受试者操作特征曲线下面积（AUROC）进行验证。
102例晚期HCC患者的中位PFS和OS率分别为9.9个月和14.3个月。对93例患者进行了疗效评估，其中5例（5.38%）完全缓解，48例（51.61%）部分缓解，总缓解率为56.99%。32.35%的患者出现3级和4级不良反应（AE）；未发生5级AE。多因素Cox分析显示，白蛋白和甲胎蛋白水平、IMRT开始后3 - 4周的中性粒细胞计数以及IMRT开始后3 - 4周的血小板与淋巴细胞比值是独立的预后因素。使用这些因素构建的列线图模型具有良好的一致性和准确性，1 - 3年的AUROC分别为78.7、78.6和93.5。
IMRT加抗PD1在治疗晚期HCC中显示出有前景的疗效和可控的不良反应。列线图模型显示出良好的可靠性和临床适用性。
