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. 2024 Mar;26(3):774-785.
doi: 10.1007/s12094-023-03314-2. Epub 2023 Aug 30.

Analysis of the prognostic value of uric acid on the efficacy of immunotherapy in patients with primary liver cancer

Hui Rao  1   2   3 , Qi Wang  4 , Xiaoli Zeng  1   5 , Xuejiao Wen  1   2 , Li Huang  6   7
Affiliations

Analysis of the prognostic value of uric acid on the efficacy of immunotherapy in patients with primary liver cancer

Hui Rao et al. Clin Transl Oncol. 2024 Mar.

Abstract

Purpose: Uric acid (UA) plays a dual role as an antioxidant and a prooxidant in patients with malignant tumors; however, the relationship between serum UA and malignancy is currently unclear. This study aims to investigate the prognostic value of serum uric acid level before immunotherapy on the efficacy of primary liver cancer (PLC) immunotherapy, which might provide a basis for optimizing the comprehensive treatment scheme.

Methods: Patients with PLC who were admitted to the First Affiliated Hospital of Gannan Medical College from January 2019 to June 2022 and underwent immunotherapy were collected retrospectively. The difference between serum UA levels in patients with PLC, the correlation between serum UA levels, and the clinical characteristics of patients with PLC were analyzed using the chi-square test, and the survival was estimated using the Kaplan-Meier analysis. To further assess the prognostic significance of UA concentrations, univariate and multivariate Cox regression analyses were performed.

Results: Ninety-nine patients were included in this study cohort. The median follow-up was 7 months (range: 1-29 months), and 76 (76.8%) of the 99 patients with PLC died as of December 31, 2022. Serum UA concentrations ranged from 105 to 670 μmol/l, with a median of 269 μmol/l. The results showed that the serum UA level of patients with PLC was higher than that of healthy subjects (P < 0.001). After subgroup analyses, only male patients with liver cancer had higher serum UA levels than healthy men (P = 0.001). The results of the Kaplan-Meier analysis showed that higher UA levels were associated with poor overall survival (OS) (P = 0.005). In univariate analysis, the OS rate of patients with elevated serum UA levels was significantly lower than the cut-off value (hazard ratio [HR]: 3.191, 95% confidence interval [CI]: 1.456-6.993, P = 0.004), with a median survival time of 151 and 312 days in the high and low serum UA groups, respectively. The results of multivariate analysis showed that the UA level was an independent prognostic factor for immunotherapy in patients with PLC (HR: 3.131, 95% CI: 1.766-5.553, P < 0.001).

Conclusions: The serum UA level is a reliable biomarker for predicting the prognosis of patients undergoing immunotherapy for PLC, and might provide a basis for the individualized treatment of these patients. Dynamic monitoring of the serum UA level may compensate for the deficiency of the current liver cancer staging system.

Keywords: Biomarkers; Efficacy; Immunotherapy; Primary liver cancer; Uric acid.

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Conflict of interest statement

The authors declare that they have no confict of interest.

Figures

Fig. 1
Fig. 1
The flow diagram of the study participant selection
Fig. 2
Fig. 2
Receiver operating characteristic (ROC) curve analysis for uric acid in predicting the efficacy of immunotherapy in patients with primary liver cancer
Fig. 3
Fig. 3
Kaplan–Meier analysis of overall survival according to uric acid levels, with low UA level (≤ 259 μmol/l) and high UA level (> 259 μmol/l)
See this image and copyright information in PMC

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