肝胆胰外科杂志2025，Vol.37Issue(3)：171-178,8.DOI:10.11952/j.issn.1007-1954.2025.03.006
脾脏对BCLC B期和C期肝细胞癌患者靶向治疗联合免疫治疗效果影响的临床研究
Impact of spleen on the efficacy of targeted therapy combined with immunotherapy in patients with BCLC stage B and C hepatocellular carcinoma
摘要
Abstract
Objective To assess the impact of the spleen on the efficacy of immune checkpoint inhibitors combined with targeted therapy in patients with BCLC stage B and C hepatocellular carcinoma(HCC).Methods A retrospective analysis was conducted on BCLC stage B and C HCC patients receiving immune checkpoint inhibitor and tyrosine kinase inhibitors at Tongji Hospital of Huazhong University of Science and Technology,between Dec.2018 and Dec.2023.Patients were divided into two groups based on whether they had undergone splenectomy:the prior splenectomy group(n=57)and the non-splenectomy group(n=70).The overall survival(OS)and progression-free survival(PFS)were collected by telephone follow-ups.Data analysis was performed with SPSS 26.0,the survival analysis was conducted with Kaplan-Meier analysis,and the prognostic factors was analyzed with Cox proportional hazards regression model.Results Till to Dec.30,2023,the median follow-up time was 18.9 months,29 patients died in the prior splenectomy group,while 41 died in the non-splenectomy group.The OS and PFS in the prior splenectomy group were significantly longer than those in the non-splenectomy group(mdeian OS:24.9 months vs 18.1 months,χ2=8.77,P=0.003;mdeian PFS:13.8 months vs 8.8 months,χ2=5.74,P=0.017).The objective response rate(ORR)in the prior splenectomy group was also significantly higher than that in the non-splenectomy group(38.6%vs 18.6%,χ2=6.31,P=0.012).Multivariate Cox regression analysis demonstrated that,prior non-splenectomy(HR=2.86,95%CI 1.64 to 4.76,P<0.001),BCLC stage C(HR=1.83,95%CI 1.11 to 3.03,P=0.018),Child-Pugh class B(HR=2.23,95%CI 1.24 to 4.01,P=0.007),portal vein invasion(HR=5.93,95%CI 3.37 to 10.43,P=0.001),and multiple tumors(>3)(HR=2.96,95%CI 1.69 to 5.18,P=0.001)were independent prognostic risk factors for OS(P<0.05).Similarly,prior non-splenectomy(HR=2.00,95%CI 1.23 to 3.23,P=0.005),BCLC stage C(HR=1.69,95%CI 1.06 to 2.69,P=0.001),ALBI grade 2(HR=1.93,95%CI 1.19 to 3.12,P=0.007),portal vein invasion(HR=1.95,95%CI 1.15 to 3.30,P=0.013),and multiple tumors(>3)(HR=2.20,95%CI 1.36 to 2.56,P=0.001)were independent prognostic risk factors for PFS(P<0.05).The overall incidence of adverse events in the non-splenectomy group(94.29%)was slightly higher than that in the prior splenectomy group(92.98%),the difference was not statistically significant(χ2=0.01,P=1.00).Conclusion Prior splenectomy has been shown to significantly extend OS and PFS in patients with BCLC stage B and C HCC who undergo targeted therapy combined with immunotherapy,thereby improving their prognosis.Additionally,prior splenectomy does not increase the risk of adverse reactions associated with targeted therapy combined with immunotherapy.关键词
原发性肝细胞癌/巴塞罗那临床肝癌分期/脾切除术/靶向治疗/免疫治疗/Cox回归分析/预后Key words
primary hepatocellular carcinoma/Barcelona Clinic Liver Cancer(BCLC)Stage/splenectomy/targeted therapy/immunotherapy/Cox regression analysis/prognosis分类
临床医学引用本文复制引用
余俊,陈孝平,王金鹏,邵天胤,周洪浩,吴俣,申雪晗,董汉华,程琪,张志伟..脾脏对BCLC B期和C期肝细胞癌患者靶向治疗联合免疫治疗效果影响的临床研究[J].肝胆胰外科杂志,2025,37(3):171-178,8.基金项目
湖北陈孝平科技发展基金会肝胆胰恶性肿瘤研究基金多中心重大专项(CXPJJH11800001-2018104). （CXPJJH11800001-2018104）
