摘要
Abstract
Objective:To investigate the clinical features and prognosis analysis of liver injury associated with immune checkpoint inhibitors(ICIs)in patients with primary liver cancer.Method:Clinical data of 100 patients with primary liver cancer who received treatment in Beijing Shuili Hospital and had a history of ICIs treatment from June 2020 to June 2021 were collected.The incidence rate and clinical characteristics of ICIS-related liver injury were analyzed.The risk factors of patients with ICIS-related liver injury were analyzed by multivariate logistic regression analysis,the patients were followed up for 3 years and overall survival(OS)was recorded.Result:Among 100 patients with primary liver cancer,36 cases of ICIS-related liver injury occurred,the incidence rate was 36.00%.The main clinical symptoms of ICIS-related liver injury were systemic skin and scleral yellow stain,and the proportion was 55.56%.The severity of grade 2,grade 3 and grade 4 accounted for 8.33%,77.78%and 13.89%respectively.Cholestasis,mixed type and hepatocyte injury accounted for 33.33%,16.67%and 50.00%,respectively.The proportion of<3 months,3～6 months and>6 months were 66.67%,27.78%and 5.56%,respectively.Univariate analysis showed that the proportion of ICIS-related liver injury group aged≥60 years,combined nonalcoholic fatty liver disease(NAFLD),ICIs type CTLA-4 was higher than that of non-liver injury group,and the differences were statistically significant(P<0.05).There were no significant differencse in gender,BMI,pathological type,TNM stage,differentiation degree,maximum diameter of cancer focus,ICIs drug and treatment plan between the two groups(P>0.05).Multi-factor logistic regression analysis showed that age≥60 years old,combined with NAFLD and CTLA-4 were risk factors for ICIS-related liver injury in patients with primary liver cancer(P<0.05).After 3 years of follow-up,the OS of primary liver cancer patients complicated with ICIS-related liver injury was 22.5 months,which was shorter than that of patients without ICIS-related liver injury(26.0 months),and the difference was statistically significant(P<0.05).Conclusion:The incidence of ICIS-related liver injury in patients with primary liver cancer is high,among which age,NAFLD and ICIs type are the main influencing factors,and there is a certain relationship between ICIS-related liver injury and patient prognosis.关键词
原发性肝癌/免疫检查点抑制剂/肝损伤/临床特征/预后Key words
Primary liver cancer/Immune checkpoint inhibitors/Liver injury/Clinical features/Prognosis
