Objective:To evaluate the prognostic value of pre-therapeutic inflammatory markers before transarterial chemoembolization with degradable starch microspheres (DSM-TACE) in the treatment of hepatocellular carcinoma (HCC).Methods:A total of 155 patients (81% male, median age: 68 years) who underwent first-time DSM-TACE between 07/13 and 06/22 were included in the study. Inflammatory indices were dichotomized using median values. Cox proportional hazard model for univariate (UVA) and multivariate (MVA) analyses (hazard ratio; 95% CI,p-value) and Kaplan–Meier analyses (overall survival (OS) in months; 95% CI; log-rank test) were performed.Results:The median OS of the study cohort was 15.9 (12.9–20) months with a median survival according to BCLC stages A (12%), B (41%), and C (47%) of median not reached, 19.3 (15.3–27), and 7.2 (4.5–9.0) months, respectively (p< 0.0001). In the UVA, several inflammatory markers on OS were statistically significant with the systemic inflammatory response index (SIRI; ≤median (2.04) HR: 0.41 (0.19–0.89);p= 0.024) and the lymphocyte to monocyte ratio (LMR; >median (1.82) HR: 0.44 (0.2–0.9);p= 0.025) remaining statistically significant in MVA together with the BCLC stage (p= 0.0001), ALBI grade (p= 0.016), hepatic tumor burden (≤25% vs. >25%;p= 0.006), and largest HCC lesion (≤5.5 cm vs. >5.5 cm;p= 0.008). In subgroup analysis, patients with elevated LMR and reduced SIRI exhibited significantly prolonged overall survival (OS) in both BCLC B (p< 0.0001) and Child–Pugh A (p= 0.021) subgroups.Conclusion:The findings suggest that SIRI and LMR may serve as valuable tools in identifying BCLC B and Child–Pugh A patients who could potentially benefit better from DSM-TACE treatment. Nevertheless, further research is recommended to confirm these findings and to provide more comprehensive insights.
目的：评估肝细胞癌（HCC）患者在接受可降解淀粉微球经动脉化疗栓塞术（DSM-TACE）治疗前，其治疗前炎症标志物对预后的预测价值。 方法：本研究共纳入155例患者（男性占81%，中位年龄68岁），这些患者在2013年7月至2022年6月期间首次接受DSM-TACE治疗。炎症指标按中位数进行二分类。采用Cox比例风险模型进行单变量（UVA）和多变量（MVA）分析（风险比；95%置信区间，p值），并采用Kaplan-Meier法分析总生存期（OS，以月计；95%置信区间；对数秩检验）。 结果：研究队列的中位OS为15.9（12.9–20）个月。按巴塞罗那肝癌分期（BCLC）A期（12%）、B期（41%）和C期（47%）划分的中位生存期分别为未达到、19.3（15.3–27）个月和7.2（4.5–9.0）个月（p < 0.0001）。在UVA中，多个炎症标志物对OS的影响具有统计学显著性，其中全身炎症反应指数（SIRI；≤中位数（2.04）HR：0.41（0.19–0.89）；p = 0.024）和淋巴细胞与单核细胞比值（LMR；>中位数（1.82）HR：0.44（0.2–0.9）；p = 0.025）在MVA中仍保持统计学显著性，同时具有显著性的还包括BCLC分期（p = 0.0001）、ALBI分级（p = 0.016）、肝脏肿瘤负荷（≤25% vs. >25%；p = 0.006）以及最大HCC病灶大小（≤5.5 cm vs. >5.5 cm；p = 0.008）。在亚组分析中，LMR升高且SIRI降低的患者在BCLC B期（p < 0.0001）和Child-Pugh A级（p = 0.021）亚组中均表现出显著延长的总生存期（OS）。 结论：研究结果表明，SIRI和LMR可作为有价值的工具，用于识别可能从DSM-TACE治疗中获益更多的BCLC B期和Child-Pugh A级患者。然而，建议进一步研究以确认这些发现并提供更全面的见解。
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