在接受阿替利珠单抗-贝伐单抗联合治疗的晚期肝细胞癌肝硬化和非肝硬化患者中，中性粒细胞与淋巴细胞比值对生存结果的影响。
Impact of neutrophil-to-lymphocyte ratio on survival outcomes among cirrhotic and non-cirrhotic patients with advanced hepatocellular carcinoma under atezolizumab-bevacizumab combination therapy.
作者信息
Pantzios Spyridon, Sidiropoulos Orestis, Syriha Antonia, Stathopoulou Ioanna, Rellou Sofia, Nychas Emmanouil, Barla Georgia, Ptohis Nikolaos, Elefsiniotis Ioannis
机构信息
Academic Department of Internal Medicine, Hepatogastroenterology Unit, "Agioi Anargyroi" General and Oncology Hospital of Kifisia, National and Kapodistrian University of Athens, Greece (Spyridon Pantzios, Orestis Sidiropoulos, Antonia Syriha, Ioanna Stathopoulou, Sofia Rellou, Emmanouil Nychas, Georgia Barla, Nikolaos Ptohis, Ioannis Elefsiniotis).
出版信息
Ann Gastroenterol. 2025 May-Jun;38(3):319-327. doi: 10.20524/aog.2025.0963. Epub 2025 Apr 22.
BACKGROUND
The efficacy of atezolizumab-bevacizumab in patients with hepatocellular carcinoma (HCC) has not been studied separately in cirrhotic and non-cirrhotic patients. Our aim was to evaluate the efficacy of atezolizumab-bevacizumab in these patients, in relation to baseline values of the neutrophil-to-lymphocyte ratio (NLR).
METHODS
We divided 57 atezolizumab-bevacizumab-treated HCC patients according to baseline NLR (>3: NLR-H, ≤3: NLR-L) and studied overall survival (OS) and progression-free survival (PFS) in 4 groups: group A, non-cirrhotic/NLR-L; group B, non-cirrhotic/NLR-H; group C, cirrhotic/NLR-L; and group D, cirrhotic/NLR-H.
RESULTS
The 4 groups were comparable except for etiology, ALBI grade, macrovascular invasion, Barcelona Clinic Liver Cancer stage and prior therapy. Median OS and PFS were 30, 10, 12 and 5 months, and 14, 4, 8 and 2 months, for groups A, B, C, D, respectively (P<0.001). By Cox regression, cirrhotic/NLR-H patients showed significantly worse OS and PFS. Cirrhotic/NLR-L patients had better OS (12 vs. 5 months, P=0.002) and PFS (8 vs. 2 months, P=0.028) compared to cirrhotic/NLR-H. NLR was significantly correlated with OS (P=0.015). Non-cirrhotic/NLR-L patients had better OS (30 vs. 10 months, P=0.006) and PFS (15 vs. 4 months, P=0.01) compared to non-cirrhotic/NLR-H patients. Prior therapy was significantly correlated with better OS (30 vs. 8 months, P<0.001) and PFS (24 vs. 4 months, P<0.001) in non-cirrhotic patients.
CONCLUSIONS
Cirrhotic/NLR-H HCC patients presented the worst survival. NLR is an independent risk factor for worse survival in cirrhotic patients. Prior therapy is the only factor significantly correlated with OS and PFS in non-cirrhotic patients.
背景
阿替利珠单抗联合贝伐珠单抗在肝细胞癌（HCC）患者中的疗效尚未在肝硬化和非肝硬化患者中分别进行研究。我们的目的是评估阿替利珠单抗联合贝伐珠单抗在这些患者中的疗效，并与中性粒细胞与淋巴细胞比值（NLR）的基线值相关联。
方法
我们根据基线NLR（>3：NLR-H，≤3：NLR-L）将57例接受阿替利珠单抗联合贝伐珠单抗治疗的HCC患者分为两组，并研究了4组患者的总生存期（OS）和无进展生存期（PFS）：A组，非肝硬化/NLR-L；B组，非肝硬化/NLR-H；C组，肝硬化/NLR-L；D组，肝硬化/NLR-H。
结果
除病因、ALBI分级、大血管侵犯、巴塞罗那临床肝癌分期和既往治疗外，4组患者具有可比性。A、B、C、D组的中位OS分别为30、10、12和5个月，中位PFS分别为14、4、8和2个月（P<0.001）。通过Cox回归分析，肝硬化/NLR-H患者的OS和PFS明显较差。与肝硬化/NLR-H患者相比，肝硬化/NLR-L患者的OS更好（12个月对5个月，P=0.002），PFS也更好（8个月对2个月，P=0.028）。NLR与OS显著相关（P=0.015）。与非肝硬化/NLR-H患者相比，非肝硬化/NLR-L患者的OS更好（30个月对10个月，P=0.006），PFS也更好（15个月对4个月，P=0.01）。在非肝硬化患者中，既往治疗与更好的OS（30个月对8个月，P<0.001）和PFS（24个月对4个月，P<0.001）显著相关。
结论
肝硬化/NLR-H HCC患者的生存期最差。NLR是肝硬化患者生存期较差的独立危险因素。既往治疗是与非肝硬化患者的OS和PFS显著相关的唯一因素。
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