CD8+ T淋巴细胞水平对晚期肝细胞癌患者免疫治疗疗效的评估价值

摘要/Abstract

摘要： 目的探讨CD8⁺ T淋巴细胞水平对晚期肝细胞肝癌患者免疫治疗疗效的评估价值。方法选择2019年3月—2022年7月徐州医科大学附属沭阳医院收治的89例晚期肝细胞癌患者,所有患者均接受免疫治疗,根据患者临床疗效分为有效组[部分缓解(PR)及完全缓解(CR)]与无效组[疾病进展(PD)及疾病稳定(SD)]。对比2组CD8⁺ T淋巴细胞水平,对比2组临床资料,分析晚期肝细胞肝癌患者免疫治疗无效的影响因素,分析CD8⁺ T淋巴细胞水平对晚期肝细胞癌患者免疫治疗无效的预测价值。结果治疗后,89例患者中SD、PD、PR、CR分别为8例、24例、57例、0例,客观缓解率(ORR)为64.04%(57/89),无效组32例,有效组57例。有效组CD8⁺ T淋巴细胞水平比无效组高[(27.85±5.32)%比(21.06±4.13)%, t=6.236, P<0.001]。无效组体力状态(ECOG)评分>0分、Child-Pugh分级为B级、巴塞罗那分期(BCLC)为终末期、低分化、肝外转移、甲胎蛋白(AFP)≥20 ng/mL的比例高于有效组(P<0.05)。Child-Pugh分级为B级、BCLC分期为终末期、AFP、CD8⁺ T淋巴细胞水平为晚期肝细胞癌患者免疫治疗无效的影响因素(P<0.05)。受试者工作特征曲线(ROC)显示,CD8⁺ T淋巴细胞水平预测晚期肝细胞癌患者免疫治疗无效的曲线下面积(AUC)为0.781(P<0.05)。结论 CD8⁺ T淋巴细胞水平可用于预测晚期肝细胞癌患者免疫治疗疗效,且CD8⁺ T淋巴细胞水平较低的患者治疗无效的风险更大。

关键词: CD8⁺ T淋巴细胞, 晚期, 肝细胞癌, 免疫治疗, 临床疗效, 预测价值

Abstract: Objective To evaluate the efficacy of CD8⁺ T lymphocytes in immunotherapy in patients with advanced hepatocellular carcinoma.Methods A total of 89 patients with advanced hepatocellular carcinoma admitted to the hospital from March 2019 to July 2022 were selected. All patients received immunotherapy. According to clinical efficacy, patients were divided into effective group (partial response (PR) and complete response (CR)) and ineffective group (disease progression (PD) and stable disease (SD)). The level of CD8⁺ T lymphocytes in the 2 groups and the clinical data in the 2 groups were compared. The influencing factors of immunotherapy ineffectiveness in patients with advanced hepatocellular carcinoma was analyzed. The predictive value of CD8⁺ T lymphocytes in patients with advanced hepatocellular carcinoma was analyzed. Results After treatment, SD, PD, PR and CR of the 89 patients were 8, 24, 57 and 0, respectively. The objective response rate (ORR) was 64.04% (57/89), with 32 cases in the ineffective group and 57 cases in the effective group The level of CD8⁺ T lymphocytes in effective group was higher than that in ineffective group (P<0.05). The ECOG score > 0, Child-Pugh classification was B grade, Barcelona stage (BCLC) was end-stage, poorly differentiated, extrahepatic metastasis, and alpha-fetoprotein (AFP) ≥20 ng/mL of proportion of cases in effective group was higher than that in the effective group (P<0.05). Child-Pugh grade B, end-stage BCLC, and AFP and CD8⁺ T lymphocyte levels were influential factors for immunotherapy efficacy in patients with advanced hepatocellular carcinoma (P<0.05). Receiver operating characteristic curve (ROC) curve showed that the area under curve (AUC) value of CD8⁺ T lymphocyte level in predicting immune response in advanced hepatocellular carcinoma patients was 0.781 (P<0.05). Conclusion CD8⁺ T lymphocyte level can be used to predict the efficacy of immunotherapy in patients with advanced hepatocellular carcinoma, and low CD8⁺ T lymphocyte level of patients have a greater risk of treatment failure.

Key words: CD8⁺ T lymphocytes, Late, Hepatocellular carcinoma, Immunotherapy, Clinical effect, Predictive value

张翔, 李莹莹, 汤青, 李伟, 孙立柱. CD8⁺ T淋巴细胞水平对晚期肝细胞癌患者免疫治疗疗效的评估价值[J]. 肝脏, 2023, 28(9): 1084-1087.

ZHANG Xiang, LI Ying-ying, TANG Qing, LI Wei, SUN Li-zhu. Evaluation value of CD8⁺ T lymphocyte level in immunotherapy efficacy in patients with advanced hepatocellular carcinoma[J]. Chinese Hepatolgy, 2023, 28(9): 1084-1087.

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