Journal of Hepatocellular Carcinoma (Nov 2020)

Association of the Pretreatment Lung Immune Prognostic Index with Survival Outcomes in Advanced Hepatocellular Carcinoma Patients Treated with PD-1 Inhibitors

  • Chen S,
  • Huang Z,
  • Jia W,
  • Tao H,
  • Zhang S,
  • Ma J,
  • Liu Z,
  • Wang J,
  • Wang L,
  • Cui P,
  • Zhang Z,
  • Huang D,
  • Wu Z,
  • Zheng X,
  • Hu Y

Journal volume & issue
Vol. Volume 7
pp. 289 – 299

Abstract

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Shixue Chen,1,2,* Ziwei Huang,2,3,* Wangping Jia,1,4,* Haitao Tao,2 Sujie Zhang,2 Junxun Ma,2 Zhefeng Liu,2 Jinliang Wang,2 Lijie Wang,2 Pengfei Cui,1,2 Zhibo Zhang,1,2 Di Huang,2,3 Zhaozhen Wu,2,3 Xuan Zheng,1,2 Yi Hu2 1Department of Graduate Administration, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Department of Medical Oncology, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3School of Medicine, Nankai University, Tianjin, People’s Republic of China; 4Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese PLA General Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yi HuDepartment of Medical Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, People’s Republic of ChinaEmail [email protected]: At present, there are no validated biomarkers that can predict whether patients with advanced hepatocellular carcinoma (aHCC) are likely to benefit from anti-PD-1 therapy. We aimed to determine whether lung immune prognostic index (LIPI) is associated with outcomes in patients with aHCC treated with PD-1 inhibitors.Patients and Methods: Patients undergoing initial treatment with PD-1 inhibitors for aHCC at a single center from January 1, 2015 to August 31, 2019 were included. The patients were stratified according to pretreatment LIPI based on a derived neutrophils/(leukocytes minus neutrophils) ratio (dNLR) ≥ 3 and a lactate dehydrogenase (LDH) level ≥ the upper limit of normal (ULN). Kaplan–Meier analysis and the Log rank test were used to calculate and compare survival between good LIPI and intermediate/poor LIPI scores. The prognostic values of LIPI for survival and disease control rate were evaluated using Cox proportional hazard and logistic regression models, respectively.Results: Of the 108 study patients, 53 (49%) had a good LIPI (dNLR < 3 and LDH normal) and 55 (51%) had intermediate/poor LIPI (dNLR ≥ 3 or/and LDH ≥ ULN). With a median follow-up of 12.4 months, intermediate/poor LIPI was independently associated with shorter overall survival (OS) (hazard ratio [HR] 4.00; 95% CI, 2.00– 8.03) and progression-free survival (PFS) (HR 2.65; 95% CI, 1.61– 4.37). The median OS for good and intermediate/poor LIPI was not reached and was 13.7 (95% CI, 8.2– 19.1) months, respectively, and the median PFS was 10.9 (95% CI, 8.9– 12.9) and 4.0 (95% CI, 2.2– 5.8) months (both P < 0.001), respectively.Conclusion: Pretreatment LIPI combined with a dNLR ≥ 3 and/or LDH ≥ ULN is associated with poor outcomes in patients with aHCC treated with PD-1 inhibitors. Further validation in large, prospective studies are warranted.Keywords: PD-1 inhibitor, hepatocellular carcinoma, biomarker, LIPI, dNLR, LDH

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