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. 2024 Jun 5:11:1015-1029.
doi: 10.2147/JHC.S462470. eCollection 2024.

Changes in Posttreatment Spleen Volume Associated with Immunotherapy Outcomes for Advanced Hepatocellular Carcinoma

Bang-Bin Chen  1   2 , Po-Chin Liang  1   2   3 , Tiffany Ting-Fang Shih  1   2 , Tsung-Hao Liu  4   5   6 , Ying-Chun Shen  4   5   6 , Li-Chun Lu  4   5   6 , Zhong-Zhe Lin  4   6 , Chiun Hsu  4   5   6 , Chih-Hung Hsu  4   5   6 , Ann-Lii Cheng  4   5   6   7 , Yu-Yun Shao  4   5   6
Affiliations

Changes in Posttreatment Spleen Volume Associated with Immunotherapy Outcomes for Advanced Hepatocellular Carcinoma

Bang-Bin Chen et al. J Hepatocell Carcinoma. .

Abstract

Purpose: We investigated whether spleen volume (SV) changes were associated with treatment outcomes in advanced hepatocellular carcinoma (HCC) patients who received immunotherapy or first-line sorafenib.

Patients and methods: Patients with advanced HCC who underwent immunotherapy or first-line sorafenib at our institute were retrospectively analyzed. CT was used to measure SV before and within 3 months of treatment initiation. Tumor assessment followed Response Evaluation Criteria in Solid Tumors version 1.1. The association between SV change and tumor response or progression-free survival (PFS) was analyzed. The inverse probability of treatment weighting (IPTW) was used to adjust for differences in baseline characteristics.

Results: The immunotherapy group comprised 143 patients (124 men, mean age, 59.8 years ± 11.2 [standard deviation]), while the sorafenib group had 57 (47 men, mean age, 59.6 years ± 9.9). SV increased in 108 (75.5%) immunotherapy and 21 (36.8%) sorafenib patients. In the immunotherapy group, patients with increased SV were more likely than those with decreased SV to have a higher disease control rate (76.9% vs 57.1%, p = 0.024) and durable clinical benefit (52.8% vs 25.7%, p = 0.005). It was also associated with extended PFS in the immunotherapy group in both the univariate (p = 0.028) and multivariate (p = 0.014) analysis. By contrast, in the sorafenib group, an increased in SV was not associated with treatment response but was presumably associated with reduced PFS (p = 0.072) in the multivariate analysis. After IPTW adjustment, the increase in SV remained a significant predictor for DCB and PFS in the immunotherapy group.

Conclusion: Most patients exhibited an increase in SV after the initiation of immunotherapy, which may be used to predict response and prognosis. However, this association was not observed in patients who received sorafenib.

Keywords: hepatocellular carcinoma; immunotherapy; response; sorafenib; survival.

Plain language summary

The study provides significant evidence that an increase in spleen volume is associated with better treatment outcomes in advanced hepatocellular carcinoma patients undergoing immunotherapy. These findings offer oncologists a new potential biomarker for optimizing treatment strategies. Specifically, increased spleen volume could be used to predict higher rates of disease control and durable clinical benefits, allowing for more personalized care.

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Conflict of interest statement

Dr Chih-Hung Hsu reports grants from Roche, grants from AstraZeneca, grants from Eli Lilly, grants from Surface Oncology, personal fees from MSD, personal fees from Eisai, outside the submitted work. The authors report no other competing interests in this work.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
CT-based SV measurement. Upper panel displays the CT scans of a 66-year-old man who underwent therapy with atezolizumab, bevacizumab, and tocilizumab. His SV increased by approximately 54.3%, from 85 cm3 at baseline to 132 cm3 at his 41-day follow-up CT scan. His condition remained stable, and he experienced a DCB, with PFS of 13.8 months. Lower panel displays the CT scans of a 39-year-old man with advanced HCC treated with sorafenib. His SV increased by approximately 34.7%, from 656 cm3 at baseline to 884 cm3 at his 42-day follow-up CT scan. Despite treatment, his condition worsened, and he exhibited PFS of 1.4 months.
Figure 3
Figure 3
Waterfall plots of optimal tumor response versus SV changes. (A) immunotherapy group. (B) sorafenib group.
Figure 4
Figure 4
Kaplan–Meier curves of PFS versus SV changes. (A) immunotherapy group. (B) sorafenib group. All p values were determined using a Log rank test.
See this image and copyright information in PMC

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