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. 2025 May 30:16:1598484.
doi: 10.3389/fimmu.2025.1598484. eCollection 2025.

Splenic volume as a predictor of survival in cancer patients treated with immune checkpoint inhibitors

Yunhua Zhang #  1   2   3 , Xin Fu #  4 , Lilong Zhang  2   3   5 , Qing Zhou  1   2   3 , Weixing Wang  2   3   5
Affiliations

Splenic volume as a predictor of survival in cancer patients treated with immune checkpoint inhibitors

Yunhua Zhang et al. Front Immunol. .

Abstract

Objective: This investigation seeks to examine the association between spleen volume and prognosis in cancer patients undergoing immune checkpoint inhibitor (ICI) treatment.

Methods: We performed a retrospective analysis involving 61 patients diagnosed with hepatocellular carcinoma (HCC) who received ICIs at our institution. We evaluated the relationship between baseline splenic volume and its changes during ICI therapy concerning overall survival (OS) and progression-free survival (PFS) using a log-rank test. To identify relevant literature, we searched databases such as PubMed, EMBASE, the Cochrane Library, and Google Scholar up until February 20, 2024. The primary metrics assessed were hazard ratios (HR) for both OS and PFS, with pooled estimates and corresponding 95% confidence intervals (CIs) calculated.

Results: Within our study population, findings demonstrated a significantly decreased OS (HR: 2.02, 95% CI: 1.08-3.77, p = 0.027) and PFS (HR: 1.84, 95% CI: 1.05-3.21, p = 0.032) in HCC patients with a high baseline spleen volume, compared to individuals with lower spleen volumes. Additionally, HCC patients who experienced an increase in spleen volume during ICI therapy exhibited significantly poorer OS (HR: 2.27, 95% CI: 1.17-4.41, p = 0.016) and PFS (HR: 2.40, 95% CI: 1.30-4.41, p = 0.005) than those whose spleen volume decreased. The meta-analysis results revealed that subjects with higher spleen volumes had a significantly reduced OS (HR: 1.74, 95% CI: 1.12-2.72, p = 0.014) and PFS (HR: 1.35, 95% CI: 1.15-1.58, p < 0.001) compared to counterparts with lower volumes. Furthermore, the data clearly highlighted that patients with increases in splenic volume faced significantly poorer clinical outcomes, as indicated by reduced OS (HR: 1.83, 95% CI: 1.36-2.46, p < 0.001) and PFS (HR: 1.70, 95% CI: 1.28-2.25, p < 0.001) relative to those with decreases in splenic size.

Conclusion: A higher baseline spleen volume and an increase in spleen volume during ICI therapy were predictors of a poor prognosis in cancer patients treated with ICI.

Keywords: cancer; hepatocellular carcinoma; immune checkpoint inhibitors; prognosis; splenic volume.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The Kaplan-Meier curve of overall survival (A) and progression-free survival (B) in the pretreatment high splenic volume and low splenic volume in our cohorts. The Kaplan-Meier curve of overall survival (C) and progression-free survival (D) according to the relative change compared to baseline splenic volume in our cohorts. HR, hazard ratio; CI, confidence interval.
Figure 2
Figure 2
The flow diagram of identifying eligible studies.
Figure 3
Figure 3
Forest plots illustrating the relationship between spleen volume and overall survival (A) and progression-free survival (B). HR, hazard ratio; CI, confidence interval; DL, DerSimonian and Laird; IV, inverse-variance model.
Figure 4
Figure 4
Sensitivity analysis of the relationship between spleen volume and overall survival (A) and progression-free survival (B). HR, hazard ratio; CI, confidence interval.
Figure 5
Figure 5
Forest plots illustrating the relationship between changes in splenic volume and overall survival (A) as well as progression-free survival (B). HR, hazard ratio; CI, confidence interval; IV, inverse-variance model.
Figure 6
Figure 6
Sensitivity analysis of the relationship between changes in splenic volume and overall survival (A) and progression-free survival (B). HR, hazard ratio; CI, confidence interval.
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