An analysis on the combination of apparent diffusion coefficient values and circulating tumor cells in evaluating the efficacy of TACE combined with PD-1 inhibitors for treating advanced liver cancer

Abstract

Abstract: Objective To analyze the value of apparent diffusion coefficient (ADC) combined with circulating tumor cells (CTC) in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) combined with programmed death receptor-1 (PD-1) inhibitors for treating advanced liver cancer. Methods Between July 2018 and July 2023, 102 patients with advanced hepatocellular carcinoma (HCC) admitted to Hai 'an Hospital of Traditional Chinese Medicine who had received TACE combined with PD-1 inhibitors treatment were enrolled in this study. Based on the treatment efficacy after 2 months, the patients were divided into an effective group and an ineffective group. The ADC, CTC, and the difference (△) between the two groups of patients before and after one month of treatment were measured. The influencing factors of treatment responsiveness in patients with advanced HCC were screened, and the evaluation value of △ADC and △CTC for the treatment efficacy were analyzed. Results After treatment, 34 (33.33%) out of 102 advanced HCC patients progressed, and 68 patients (66.67%) showed stable or remission. The proportion of CNLC stage IV and Child Pugh grade C in the effective group was lower than that in the ineffective group [(41.2% (28/68) and 73.5% (25/34) in CNLC stage IV, and 20.6% (14/68) and 52.9% (18/34) in Child Pugh grade C, respectively) (P<0.05)]. After treatment, the effective group had higher ADC than the ineffective group (2.3 ± 0.5) mm²/s and (1.9 ± 0.4) mm²/s, respectively), while the CTC was lower than that of the ineffective group (19.3 ± 2.9 and 34.5 ± 3.8, respectively) (P<0.05); The effective group had significantly higher △ADC [(0.6 ± 0.2) mm²/s] and △CTC [(0.3±0.1) mm²/s, respectively] compared to the ineffective group (20.7 ± 2.5 and 5.2 ± 1.6, respectively) (P<0.05). CNLC staging (OR=3.53, 95% CI: 1.20-10.31), Child Pugh grading (OR=3.22, 95% CI: 1.10-9.43), △ADC (OR=0.28, 95% CI: 0.09-0.81), and △CTC (OR=0.21, 95% CI: 0.07-0.61) are all influencing factors for treatment response in advanced HCC patients (P<0.05). The sensitivity and specificity of single and combined evaluation of efficacy for advanced HCC with △ADC and △CTC were 0.62, 0.76, and 0.81, respectively. The AUC was 0.71, 0.73, and 0.81, respectively. Conclusion The efficacy of TACE combined with PD-1 inhibitors in evaluating the changes of ADC and CTC before and after treatment in patients with advanced HCC is good.

Key words: Hepatocellular carcinoma, Late stage, Transcatheter hepatic artery chemoembolization, Immunotherapy, Apparent diffusion coefficient value, Circulating tumor cell

ZHNAG Hong-juan, ZHOU Heng-chen, ZHOU Jian-jun, HUANG Kai-hong. An analysis on the combination of apparent diffusion coefficient values and circulating tumor cells in evaluating the efficacy of TACE combined with PD-1 inhibitors for treating advanced liver cancer[J]. Chinese Hepatolgy, 2024, 29(6): 652-656.

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