Frontiers in Immunology (Feb 2022)

C-Reactive Protein Levels Predict Responses to PD-1 Inhibitors in Hepatocellular Carcinoma Patients

  • Yiyang Zhang,
  • Yiyang Zhang,
  • Yiyang Zhang,
  • Lianghe Lu,
  • Lianghe Lu,
  • Zhangping He,
  • Zhangping He,
  • Zhishen Xu,
  • Zhishen Xu,
  • Zhicheng Xiang,
  • Zhicheng Xiang,
  • Run-Cong Nie,
  • Run-Cong Nie,
  • Wenping Lin,
  • Wenping Lin,
  • Wenxu Chen,
  • Wenxu Chen,
  • Jie Zhou,
  • Jie Zhou,
  • Yixin Yin,
  • Yixin Yin,
  • Juanjuan Xie,
  • Juanjuan Xie,
  • Youcheng Zhang,
  • Youcheng Zhang,
  • Xueyi Zheng,
  • Xueyi Zheng,
  • Tianchen Zhu,
  • Tianchen Zhu,
  • Xiaoxia Cai,
  • Xiaoxia Cai,
  • Peng Li,
  • Peng Li,
  • Xue Chao,
  • Xue Chao,
  • Mu-Yan Cai,
  • Mu-Yan Cai

DOI
https://doi.org/10.3389/fimmu.2022.808101
Journal volume & issue
Vol. 13

Abstract

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BackgroundSerum C-reactive protein (CRP) is a biomarker of an acute inflammatory response and has been successfully used as a prognostic predictor for several malignancies. However, the clinicopathological significance of CRP levels in hepatocellular carcinoma (HCC) patients being treated with PD-1 inhibitors remains unclear.MethodsSerum CRP levels were measured for a total of 101 HCC patients that had been treated with PD-1 inhibitors from July 2018 to November 2019. The clinicopathological data was retrospectively analyzed to identify any clinical implications between CRP levels and responses to PD-1 inhibitors and patients’ progression-free survival (PFS).ResultsThe median PFS was 8.87 months in the CRP-low subgroup and 3.67 months in the CRP-high subgroup (P = 0.009). Univariate and multivariate Cox regression analysis demonstrated that both serum CRP and AFP levels were independent risk factors for the PFS of HCC patients treated with PD-1 inhibitors (P < 0.05). Moreover, Cox regression analysis after Propensity Score Matching showed the similar results. A prognostic model combining CRP and AFP levels could significantly stratify HCC patients receiving PD-1 inhibitors into low-, intermediate-, and high-risk subgroups (P < 0.001). Patients in the risk subgroups reported similar overall response rates (P = 0.625) and significantly different disease control rates (low- vs. intermediate- vs. high-risk groups: 81.6% vs. 65.1% vs. 35%, respectively, P = 0.002).ConclusionsThe results of this study support the association between high serum CRP levels with the response and PFS for HCC patients receiving PD-1 inhibitors. Furthermore, the levels of both CRP and AFP in an HCC patient before treatment initiation show great potential for determining the efficacy of PD-1 inhibitors.

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