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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of baseline body mass index on the long-term prognosis of advanced hepatocellular carcinoma treated with immunotherapy
Yu-Qin Wang, Di Pan, Zhi-Yuan Yao, Yu-Qi Li, Peng-Fei Qu, Run-Bang Wang, Qing-Hao Gu, Jie Jiang, Zheng-Xiang Han, Hao-Nan Liu
Yu-Qin Wang, Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Di Pan, Zhi-Yuan Yao, Yu-Qi Li, Zheng-Xiang Han, Hao-Nan Liu, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Peng-Fei Qu, Department of Gastroenterology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Run-Bang Wang, Qing-Hao Gu, The First College of Clinical Medicine, Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Jie Jiang, Department of Oncology, Suining County People’s Hospital, Xuzhou 221000, Jiangsu Province, China
Co-first authors: Yu-Qin Wang and Di Pan.
Co-corresponding authors: Zheng-Xiang Han and Hao-Nan Liu.
Author contributions: Wang YQ, Pan D, Han ZX, and Liu HN contributed to the conceptualization, writing-review and editing of this manuscript; Wang YQ and Liu HN were responsible for the methodology of this study; Wang YQ contributed to the formal analysis of this manuscript; Wang YQ, Pan D, and Yao ZY took part in the writing-original draft; Wang YQ, Han ZX, and Liu HN contributed to the project administration; Pan D, Yao ZY, and Li YQ were involved in the investigation of this manuscript; Pan D, Qu PF, and Wang RB took part in the data curation of this study; Pan D, Han ZX, and Liu HN contributed to the supervision of this manuscript; Li YQ, Qu PF, Gu QH, and Jiang J were responsible for the validation of this manuscript; Yao ZY contributed to the visualization of this article; Li YQ took part in the resources; Han ZX and Liu HN were involved in the supervision of this study. Wang YQ and Pan D contributed equally to the manuscript, they are co-first authors of this manuscript. Han ZX and Liu HN contributed to this manuscript equally, they are co-corresponding authors of this study.
Institutional review board statement: This research was carried out following the Declaration of Helsinki and received approval from the Ethics Committee at the Affiliated Hospital of Xuzhou Medical University (approval No. XYFY2022-KL207-01).
Informed consent statement: Given the retrospective design of this investigation, the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University granted us an exemption from obtaining written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data included in this study can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hao-Nan Liu, Doctor, Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou 221000, Jiangsu Province, China.
why974300@163.com
Received: August 3, 2024
Revised: August 29, 2024
Accepted: September 10, 2024
Published online: October 7, 2024
Processing time: 53 Days and 12.6 Hours
BACKGROUND
Primary liver cancer is the sixth most common cancer worldwide, with hepatocellular carcinoma (HCC) being the most prevalent form. Despite the current availability of multiple immune or immune combination treatment options, the prognosis is still poor, so how to identify a more suitable population is extremely important.
AIM
To evaluate the clinical effectiveness of combining lenvatinib with camrelizumab for patients with hepatitis B virus (HBV)-related HCC in Barcelona Clinic Liver Cancer (BCLC) stages B/C, considering various body mass index (BMI) in different categories.
METHODS
Retrospective data were collected from 126 HCC patients treated with lenvatinib plus camrelizumab. Patients were divided into two groups based on BMI: The non-overweight group (BMI < 25 kg/m2, n = 51) and the overweight/obese group (BMI ≥ 25 kg/m2, n = 75). Short-term prognosis was evaluated using mRECIST criteria, with subgroup analyses for non-overweight (BMI: 18.5-24.9 kg/m2), overweight (BMI: 25-30 kg/m2), and obese (BMI ≥ 30 kg/m2) patients. A Cox proportional hazards regression analysis identified independent prognostic factors for overall survival (OS), leading to the development of a column-line graph model.
RESULTS
Median progression-free survival was significantly longer in the obese/overweight group compared to the non-overweight group. Similarly, the median OS was significantly prolonged in the obese/overweight group than in the non-overweight group. The objective remission rate and disease control rate for the two groups of patients were, respectively, objective remission rate (5.88% vs 28.00%) and disease control rate (39.22% vs 62.67%). Fatigue was more prevalent in the obese/overweight group, while other adverse effects showed no statistically significant differences (P > 0.05). Subgroup analysis based on BMI showed that obese and overweight patients had better progression-free survival and OS than non-overweight patients, with obese patients showing the best outcomes. Multifactorial regression analysis identified BCLC grade, alpha-fetoprotein level, portal vein tumor thrombosis, and BMI as independent prognostic factors for OS. The column-line graph model highlighted the importance of BMI as a major predictor of patient prognosis, followed by alpha-fetoprotein level, BCLC classification, and portal vein tumor thrombosis.
CONCLUSION
BMI is a long-term predictor of the efficacy of lenvatinib plus camrelizumab, and obese/overweight patients have a better prognosis.
Core Tip: Primary liver cancer is the sixth most common cancer and the third leading cause of cancer-related death worldwide, with hepatocellular carcinoma (HCC) being the most prevalent form. Numerous combination therapies involving programmed cell death protein 1/programmed cell death ligand 1 inhibitors and antiangiogenic targeted therapies have been investigated and approved as first-line systemic therapy for patients with advanced HCC. In the era of immune checkpoint inhibitors, nutritional assessment, including body mass index (BMI), can be considered a new prognostic predictor. However, the impact of BMI on the prognosis of patients with hepatitis B virus-related HCC remains controversial. We initiated a retrospective clinical study to explore the impact of BMI level on the prognosis of hepatitis B virus-related HCC patients treated with lenvatinib plus carelizumab.
