通过非侵入性CT成像评估的髓样反应可预测肝细胞癌患者的术后生存率和免疫检查点治疗效果。

Myeloid response evaluated by noninvasive CT imaging predicts post-surgical survival and immune checkpoint therapy benefits in patients with hepatocellular carcinoma.

作者信息

Peng Kangqiang, Zhang Xiao, Li Zhongliang, Wang Yongchun, Sun Hong-Wei, Zhao Wei, Pan Jielin, Zhang Xiao-Yang, Wu Xiaoling, Yu Xiangrong, Wu Chong, Weng Yulan, Lin Xiaowen, Liu Dingjie, Zhan Meixiao, Xu Jing, Zheng Limin, Zhang Yaojun, Lu Ligong

机构信息

State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China.

Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Institute of Translational Medicine, Zhuhai People's Hospital (Zhuhai Clinical Medical College), Jinan University, Zhuhai, China.

出版信息

Front Immunol. 2024 Dec 2;15:1493735. doi: 10.3389/fimmu.2024.1493735. eCollection 2024.

DOI:10.3389/fimmu.2024.1493735

PMID:39687612

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11646988/

Abstract

BACKGROUND

The potential of preoperative CT in the assessment of myeloid immune response and its application in predicting prognosis and immune-checkpoint therapy outcomes in hepatocellular carcinoma (HCC) has not been explored.

METHODS

A total of 165 patients with pathological slides and multi-phase CT images were included to develop a radiomics signature for predicting the imaging-based myeloid response score (iMRS). Overall survival (OS) and recurrence-free survival (RFS) were assessed according to the iMRS risk group and validated in a surgical resection cohort ( = 98). The complementary advantage of iMRS incorporating significant clinicopathologic factors was investigated by the Cox proportional hazards analysis. Additionally, the iMRS in inferring the benefits of immune checkpoint therapy was explored in an immunotherapy cohort ( = 36).

RESULTS

We showed that AUCs of the optimal radiomics signature for iMRS were 0.941 [95% confidence interval (CI), 0.909-0.973] and 0.833 (0.798-0.868) in the training and test cohorts, respectively. High iMRS was associated with poor RFS and OS. The prognostic performance of the Clinical-iMRS nomogram was better than that of a single parameter ( < 0.05), with a 1-, 3-, and 5-year C-index for RFS of 0.729, 0.709, and 0.713 in the training, test, and surgical resection cohorts, respectively. A high iMRS score predicted a higher proportion of objective response (vs. progressive disease or stable disease; odds ratio, 2.311; 95% CI, 1.144-4.672; = 0.020; AUC, 0.718) in patients treated with anti-PD-1 and PD-L1.

CONCLUSIONS

iMRS may provide a promising method for predicting local myeloid immune responses in HCC patients, inferring postsurgical prognosis, and evaluating benefits of immune checkpoint therapy.

摘要

背景

术前CT在评估髓系免疫反应方面的潜力及其在预测肝细胞癌（HCC）预后和免疫检查点治疗结果中的应用尚未得到探索。

方法

纳入165例有病理切片和多期CT图像的患者，以建立预测基于影像学的髓系反应评分（iMRS）的放射组学特征。根据iMRS风险组评估总生存期（OS）和无复发生存期（RFS），并在手术切除队列（n = 98）中进行验证。通过Cox比例风险分析研究iMRS结合显著临床病理因素的互补优势。此外，在免疫治疗队列（n = 36）中探索iMRS在推断免疫检查点治疗益处方面的作用。

结果

我们发现，训练队列和测试队列中iMRS的最佳放射组学特征的AUC分别为0.941[95%置信区间（CI），0.909 - 0.973]和0.833（0.798 - 0.868）。高iMRS与较差的RFS和OS相关。临床-iMRS列线图的预后性能优于单一参数（P < 0.05），训练队列、测试队列和手术切除队列中RFS的1年、3年和5年C指数分别为0.729、0.709和0.713。高iMRS评分预测接受抗PD - 1和PD - L1治疗的患者客观缓解率更高（相对于疾病进展或稳定；优势比，2.311；95%CI，1.144 - 4.672；P = 0.020；AUC，0.718）。