Ji Zhengzheng, Li Jiasong, Zhang Shasha, Jia Yuanyuan, Zhang Jing, Guo Zhanjun
Department of Rheumatology and Immunology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Gerontology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Front Immunol. 2024 Nov 27;15:1480520. doi: 10.3389/fimmu.2024.1480520. eCollection 2024.
Chronic viral infection may lead to an immunosuppressive microenvironment, whereas the association between virus-related indicators and treatment response in hepatocellular carcinoma(HCC) patients undergoing immune checkpoint inhibitors(ICIs) therapy remains a topic of debate. We aim to investigate the influence of hepatitis virus on the ICI efficiency in HCC patients through a meta-analysis.
We searched PubMed, Cochrane Library, Embase, and Web of Science until 14 July 2024 to identify cohort studies involving ICIs treatments in HCC patients. We extracted data from the literature related to hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection, baseline HBV load, and antiviral therapy. Overall survival (OS) and progression-free survival (PFS) were considered as the primary endpoints, while objective response rate (ORR) was regarded as a secondary endpoint.
We included 55 cohort studies published between 2019 and 2024, involving a patient population of 7180 individuals. Summarized hazard ratio (HR) comparing HBV infection with non-HBV infection in the context of ICIs therapy revealed no significant association between HBV infection and either mortality risk or progression risk with the pooled HR for OS of 1.04(95%CI: 0.93-1.16, P=0.483) and the pooled HR for PFS of 1.07(95%CI:0.96-1.20, P=0.342). HBV infected patients with HCC may have better tumor response than non-HBV infected patients receiving ICIs with the combined relative risk(RR) for ORR was 1.94 (95%CI: 1.12-3.38, P=0.002). High baseline HBV load is associated with poor survival outcomes in patients with HCC who receive ICIs with the pooled HR for OS was 1.74 (95%CI: 1.27-2.37, P=0.001), thereby antiviral therapy has the potential to significantly enhance prognostic outcomes with the pooled HR for OS was 0.24 (95% CI: 0.14-0.42 P<0.001) and the pooled HR for PFS was 0.54 (95% CI: 0.33-0.89 P=0.014).
In individuals with HCC who received ICIs, there was no notable link found between HBV or HCV infection and prognosis. However, HBV infection showed a connection with improved tumor response. A higher initial HBV load is linked to worse survival results in HCC patients undergoing ICIs treatment and antiviral therapy can significantly improve its prognosis.
慢性病毒感染可能导致免疫抑制微环境，而在接受免疫检查点抑制剂（ICI）治疗的肝细胞癌（HCC）患者中，病毒相关指标与治疗反应之间的关联仍是一个有争议的话题。我们旨在通过荟萃分析研究肝炎病毒对HCC患者ICI疗效的影响。
我们检索了截至2024年7月14日的PubMed、Cochrane图书馆、Embase和科学网，以确定涉及HCC患者ICI治疗的队列研究。我们从与乙型肝炎病毒（HBV）感染、丙型肝炎病毒（HCV）感染、基线HBV载量和抗病毒治疗相关的文献中提取数据。总生存期（OS）和无进展生存期（PFS）被视为主要终点，而客观缓解率（ORR）被视为次要终点。
我们纳入了2019年至2024年发表的55项队列研究，涉及7180名患者。在ICI治疗背景下，比较HBV感染与非HBV感染的汇总风险比（HR）显示，HBV感染与死亡风险或进展风险之间无显著关联，OS的汇总HR为1.04（95%CI：0.93-1.16，P=0.483），PFS的汇总HR为1.07（95%CI：0.96-1.20，P=0.342）。接受ICI治疗的HBV感染HCC患者可能比未感染HBV的患者有更好的肿瘤反应，ORR的合并相对风险（RR）为1.94（95%CI：1.12-3.38，P=0.002）。接受ICI治疗的HCC患者中，高基线HBV载量与较差的生存结果相关，OS的汇总HR为1.74（95%CI：1.27-2.37，P=0.001），因此抗病毒治疗有可能显著改善预后，OS的汇总HR为0.24（95%CI：0.14-0.42，P<0.001），PFS的汇总HR为0.54（95%CI：0.33-0.89，P=0.014）。
在接受ICI治疗的HCC患者中，未发现HBV或HCV感染与预后之间存在显著联系。然而，HBV感染显示出与改善肿瘤反应有关。较高的初始HBV载量与接受ICI治疗的HCC患者较差的生存结果相关，抗病毒治疗可显著改善其预后。
