Evolution of liver function during immune checkpoint inhibitor treatment for hepatocellular carcinoma.

IF 5.8 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY United European Gastroenterology Journal Pub Date : 2024-10-01 Epub Date: 2024-07-11 DOI:10.1002/ueg2.12626

Katharina Pomej, Lorenz Balcar, Sabrina Sidali, Riccardo Sartoris, Tobias Meischl, Michael Trauner, Mattias Mandorfer, Thomas Reiberger, Maxime Ronot, Mohamed Bouattour, Matthias Pinter, Bernhard Scheiner

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Abstract

Background and aims: Deterioration of liver function is a leading cause of death in patients with advanced hepatocellular carcinoma (HCC). We evaluated the impact of immune checkpoint inhibitor (ICI)-treatment on liver function and outcomes.

Method: HCC patients receiving ICIs or sorafenib between 04/2003 and 05/2024 were included. Liver function (assessed by Child-Pugh score [CPS]) was evaluated at the start of ICI-treatment (baseline, BL) and 3 and 6 months thereafter. A ≥1 point change in CPS was defined as deterioration (-) or improvement (+), while equal CPS points were defined as stable (=).

Results: Overall, 182 ICI-treated patients (66.8 ± 11.8 years; cirrhosis: n = 134, 74%) were included. At BL, median CPS was 5 (IQR: 5-6; CPS-A: 147, 81%). After 3 months, liver function improved/stabilized in 102 (56%) and deteriorated in 61 (34%) patients, while 19 (10%) patients deceased/had missing follow-up (d/noFU). Comparable results were observed at 6 months (+/=: n = 82, 45%; -: n = 55, 30%; d/noFU: n = 45, 25%). In contrast, 54 (34%) and 33 (21%) out of 160 sorafenib patients achieved improvement/stabilization at 3 and 6 months, respectively. Radiological response was linked to CPS improvement/stabilization at 6 months (responders vs. non-responders, 73% vs. 50%; p = 0.007). CPS improvement/stabilization at 6 months was associated with better overall survival following landmark analysis (6 months: +/=: 28.4 [95% CI: 18.7-38.1] versus -: 14.2 [95% CI: 10.3-18.2] months; p < 0.001). Of 35 ICI-patients with CPS-B at BL, improvement/stabilization occurred in 16 (46%) patients, while 19 (54%) patients deteriorated/d/noFU at 3 months. Comparable results were observed at 6 months (CPS +/=: 14, 40%, -: 8, 23%). Importantly, 6/35 (17%) and 9/35 (26%) patients improved from CPS-B to CPS-A at 3 and 6 months.

Conclusion: Radiological response to ICI-treatment was associated with stabilization or improvement in liver function, which correlated with improved survival, even in patients with Child-Pugh class B at baseline.

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免疫检查点抑制剂治疗肝细胞癌期间肝功能的变化。

背景和目的：肝功能恶化是晚期肝细胞癌（HCC）患者死亡的主要原因。我们评估了免疫检查点抑制剂（ICI）治疗对肝功能和预后的影响：方法：纳入2003年4月至2024年5月期间接受ICI或索拉非尼治疗的HCC患者。在 ICI 治疗开始时（基线，BL）及其后 3 个月和 6 个月评估肝功能（通过 Child-Pugh 评分 [CPS] 评估）。CPS变化≥1分定义为恶化（-）或改善（+），CPS分数相同定义为稳定（=）：共纳入 182 名接受过 ICI 治疗的患者（66.8 ± 11.8 岁；肝硬化：134 人，占 74%）。在BL期，CPS中位数为5（IQR：5-6；CPS-A：147，81%）。3 个月后，102 例（56%）患者的肝功能改善/稳定，61 例（34%）患者的肝功能恶化，19 例（10%）患者死亡/缺少随访（d/noFU）。6 个月后观察到的结果相当（+/=：n = 82，45%；-：n = 55，30%；d/noFU：n = 45，25%）。相比之下，160 名索拉非尼患者中分别有 54 人（34%）和 33 人（21%）在 3 个月和 6 个月时病情得到改善/稳定。放射学反应与6个月时CPS的改善/稳定有关（有反应者与无反应者，73%与50%；P = 0.007）。地标分析显示，6 个月时的 CPS 改善/稳定与更好的总生存率相关（6 个月：6个月：+/=：28.4个月[95% CI：18.7-38.1]对-：14.2个月[95% CI：10.3-18.2]；P 结论：对 ICI 治疗的放射学反应与肝功能的稳定或改善相关，而肝功能的稳定或改善与生存率的提高相关，即使是基线为 Child-Pugh B 级的患者也是如此。

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来源期刊

United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

10.50

自引率

13.30%

发文量

147

期刊介绍： United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.