Correlation Analysis Of Lymphocyte Subsets Characteristics With The Efficacy Of Comprehensive Treatment For Patients With Intermediate To Advanced Hepatocellular Carcinoma

Background and Objective:Hepatocellular carcinoma(HCC)is one of the most common cancers in the world,and its incidence rate is high in China.Since patients with hepatocellular carcinoma have no obvious clinical symptoms in the early stage,most of them are already in the middle to late stage(BCLC B or C)at the time of initial diagnosis,losing the opportunity for radical surgery.For this group of patients,treatment options are limited.However,with the continuous research on the mechanism of hepatocellular carcinoma,the understanding of hepatocellular carcinoma has been improving.Systemic therapy represented by tyrosine kinase inhibitors(TKIs)and immune checkpoint inhibitors(ICIs)has opened a new era of treatment for liver cancer.Combination regimens have gradually matured from the initial interventional combined with targeted,targeted combined with immune,to the highly regarded triple combination of interventional combined with targeted + immune,which can significantly improve the complete remission rate(CR)and overall survival time(OS).However,there are multiple combination regimens of TKIs and ICIs,and the efficacy of different combinations of regimens varies among patients.Thus,finding the right markers is urgent.We clinically hope that the efficacy of triple combination regimens can be effectively predicted for patients in order to individualize treatment for different patients and select the best treatment plan for them.To this end,a retrospective study was conducted to explore the clinical efficacy of triple combination therapy in patients with intermediate to advanced hepatocellular carcinoma,to analyze the independent risk factors involved,and to investigate the correlation between the characteristics of lymphocyte subpopulation changes and the efficacy of triple combination therapy,so as to provide clinicians with effective predictive markers and to guide them in formulating individualized treatment plans for patients so that they can achieve satisfactory results.Methods:Retrospective analysis of 55 patients with intermediate to advanced hepatocellular carcinoma in the Second Affiliated Hospital of Nanchang University from July 1,2020 to January 31,2023,were evaluated for tumor response according to the m RECIST criteria and divided into remission group(CR+PR),unremitting group(SD+PD)of which 29 cases remission group,26 cases unremitting group,using Kaplan-Meier was used to calculate the progression-free survival time(PFS)and overall survival time(OS)to draw survival curves.The surgical conversion resection rate and treatment-related adverse effects(AE)were recorded.And the changes of TBNK lymphatic subpopulation before and after treatment were analyzed in both groups.Results:1.By mRECIST criteria,CR,PR,SD,and PD were 11(20.0%),18(32.7%),17(30.9%),and 9(16.4%),respectively.the ORR,DCR,and surgical conversion rates were 52.7%(29/55),83.6%(46/55),and 20.0%(11/55),respectively.2.The mOS was 18 months in the unremitted group and was higher in the remitted group than in the unremitted group [hazard ratio(HR):0.060,95% CI:0.178-0.205,P <0.001].The mPFS was 9 months in the unremitting group and higher in the remitting group than in the unremitting group [hazard ratio(HR):0.324,95% CI:0.147-0.716,P= 0.002].The overall survival(OS)and progression-free survival(PFS)were significantly better in the remission group than in the non-remission group with statistically signifacant differences(P<0.05)3.The results of COX regression analysis of progression-free survival showed that portal vein cancer embolism and initial HAIC response were prognostic independent factors for(PFS),P<0.05.4.Grade 1-2 adverse events were predominant in both groups,and there were no deaths associated with adverse reactions in either group.There were no statistically significant adverse reactions between the two groups.5.CD8+%,CD19+%,and CD19+ cell absolute count values were statistically significant before and after treatment in the remission and non-remission groups,p<0.05.In the objective remission group,CD8+% increased after treatment compared to before treatment,and CD19+% and CD19+ absolute count values decreased after treatment compared to before treatment;while in the non-remission group,CD8+%decreased after treatmentConclusions:1.Combination therapy regimens are safe and effective in the treatment of patients with intermediate to advanced hepatocellular carcinoma.2.Portal vein carcinoma thrombosis and initial HAIC non-response are independent prognostic risk factors for progression-free survival in patients with intermediate to advanced hepatocellular carcinoma treated with combination therapy.3.Decreased CD8+ percentage,increased CD19+ percentage,and absolute CD19+ count values after combination therapy in patients with intermediate to advanced hepatocellular carcinoma may predict poor patient prognosis and can be used as potential biomarkers.