He Tian, Xu Bin, Wang Lu-Na, Wang Zi-Yi, Shi Huan-Chen, Zhong Cheng-Jie, Zhu Xiao-Dong, Shen Ying-Hao, Zhou Jian, Fan Jia, Sun Hui-Chuan, Hu Bo, Huang Cheng
Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University180 Fenglin Road, Shanghai, 200032, China.
Biomark Res. 2025 Jan 14;13(1):10. doi: 10.1186/s40364-024-00722-6.
Predicting the efficacy of immune-based therapy in patients with unresectable hepatocellular carcinoma (HCC) remains a clinical challenge. This study aims to evaluate the prognostic value of the systemic immune-inflammation index (SII) in forecasting treatment response and survival outcomes for HCC patients undergoing immune-based therapy.
We analyzed a cohort of 268 HCC patients treated with immune-based therapy from January 2019 to March 2023. A training cohort of 93 patients received atezolizumab plus bevacizumab (T + A), while a validation cohort of 175 patients underwent treatment with tyrosine kinase inhibitors (TKIs) combined with anti-PD-(L)1 therapy. The SII cutoff value, determined using X-tile analysis based on overall survival (OS) in the training cohort, divided patients into high (> 75210) and low (≤ 75210) SII groups. Prognostic factors were identified through univariate and multivariate logistic and Cox regression analyses, and survival outcomes were assessed using Kaplan-Meier methods. The predictive accuracy of SII was evaluated using receiver operating characteristic (ROC) curves.
An optimal SII cutoff of 752*10 stratified patients into high and low SII groups. Univariate and multivariate logistic regression indicated that SII was a significant predictor of the objective response rate (ORR), which was markedly different between the low and high SII subgroups (34.72% vs. 9.52%, P = 0.019). This finding was consistent in the validation cohort (34.09% vs. 16.28%, P = 0.026). SII also demonstrated prognostic value in Cox regression and Kaplan-Meier analyses. ROC curves confirmed that SII had superior predictive accuracy compared to common clinical indicators, with predictive relevance even in AFP-negative patients. Furthermore, a lower SII was associated with a higher T cell ratio and an increased number of CD8 T cells and Granzyme B CD8 T cells in peripheral blood.
SII is a promising predictor of both therapeutic efficacy and prognosis in HCC patients undergoing immune-based treatments. Its application may enhance clinical decision-making, thereby improving patient outcomes from immune-based therapy.
预测不可切除肝细胞癌（HCC）患者基于免疫治疗的疗效仍然是一项临床挑战。本研究旨在评估全身免疫炎症指数（SII）在预测接受免疫治疗的HCC患者治疗反应和生存结局方面的预后价值。
我们分析了2019年1月至2023年3月接受免疫治疗的268例HCC患者队列。93例患者的训练队列接受阿替利珠单抗联合贝伐单抗（T+A）治疗，而175例患者的验证队列接受酪氨酸激酶抑制剂（TKIs）联合抗PD-（L）1治疗。根据训练队列中的总生存期（OS），使用X-tile分析确定SII临界值，将患者分为高（>752×10）和低（≤752×10）SII组。通过单因素和多因素逻辑回归及Cox回归分析确定预后因素，并使用Kaplan-Meier方法评估生存结局。使用受试者工作特征（ROC）曲线评估SII的预测准确性。
最佳SII临界值为752×10，将患者分为高SII组和低SII组。单因素和多因素逻辑回归表明，SII是客观缓解率（ORR）的显著预测因子，低SII亚组和高SII亚组之间的ORR显著不同（34.72%对9.52%，P=0.019）。这一发现在验证队列中一致（34.09%对16.28%，P=0.026）。SII在Cox回归和Kaplan-Meier分析中也显示出预后价值。ROC曲线证实，SII与常见临床指标相比具有更高的预测准确性，即使在甲胎蛋白（AFP）阴性患者中也具有预测相关性。此外，较低的SII与外周血中较高的T细胞比例以及CD8 T细胞和颗粒酶B CD8 T细胞数量增加相关。
SII是接受免疫治疗的HCC患者治疗疗效和预后的有前景的预测指标。其应用可能会加强临床决策，从而改善免疫治疗的患者结局。
