关键词: 癌，肝细胞, T淋巴细胞亚群, 炎症指标, 经导管动脉化疗栓塞, 骨髓抑制

Abstract:

Objective To explore the predictive value of T cell subtype characteristics and peripheral blood inflammatory indicators in patients with liver cancer for myelosuppression after hepatic artery infusion chemotherapy. Methods A total of 115 patients with primary hepatocellular carcinoma who received transcatheter arterial chemoembolization （TACE） treatment in the Department of Oncology of Taizhou Jiangyan Traditional Chinese Medicine Hospital from May 2022 to May 2024 were enrolled as the research subjects. According to whether myelosuppression occurred after TACE treatment，the patients were divided into a non-myelosuppression group （n=93） and a myelosuppression group （n=22）. The clinical data，the proportions of T cell subsets before TACE treatment，and the differences in the levels of peripheral blood inflammatory indexes were compared between the two groups. Spearman correlation analysis and multivariate logistic regression analysis were used to screen out the influencing factors of myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. The receiver operator characteristic （ROC） curve was used to analyze the efficacy of each influencing factor in predicting the myelosuppression of patients. Results There were no statistically significant differences in age，sex，history of hypertension，body mass index，type of hepatitis virus infection，status of hypersplenism，Barcelona staging，Child-Pugh classification of liver function，number of TACE treatments，and the proportion of CD8⁺ T cells between the patients in the myelosuppression group and non-myelosuppression group （all P>0.05）. However，there were statistically significant differences in diabetes （χ²=3.94，P=0.047），history of alcohol consumption （χ²=5.47，P=0.019），the longest diameter of the tumor （Z=2.31，P=0.021），the presence of ascites （χ²=4.10，P=0.043），the proportion of CD4⁺ T cells （t=4.66，P<0.001），the ratio of CD4⁺/CD8⁺ （t=4.98，P<0.001），the neutrophil/lymphocyte ratio （NLR）（t=4.98，P<0.001），the monocyte/lymphocyte ratio （MLR）（t=2.31，P=0.023），and the systemic immune inflammation index （SII）（t=5.31，P<0.001）. Spearman correlation analysis showed that diabetes （r=0.19，P=0.048），history of alcohol consumption （r=0.22，P=0.019），the presence of ascites （r=0.19，P=0.043），the longest diameter of the tumor （r=0.22，P=0.020），NLR （r=0.39，P<0.001），MLR （r=0.30，P=0.001），and SII （r=0.36，P<0.001） were all positively correlated with myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma，while the proportion of CD4⁺ T cells （r=-0.37，P<0.001） and the ratio of CD4⁺/CD8⁺ （r=-0.40，P<0.001） were negatively correlated with myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. Multivariate logistic regression analysis showed that the ratio of CD4⁺/CD8⁺ （OR=0.01，95%CI： 0.01-0.11，P=0.002） was an independent protective factor for myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma，and NLR （OR=1.82，95%CI： 1.31-5.60，P=0.013） and SII （OR=1.03，95%CI： 1.01-1.05，P=0.002） were both independent risk factors for myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma. ROC curve analysis showed that the areas under the curve （AUCs） of the ratio of CD4⁺/CD8⁺，NLR，and SII for predicting myelosuppression after TACE treatment in patients with primary hepatocellular carcinoma alone were 0.79 （95%CI： 0.70-0.89），0.78 （95%CI： 0.65-0.92），and 0.76 （95%CI： 0.65-0.87），respectively. The AUC of the combined prediction of the three was 0.91 （95%CI： 0.83-0.99），which was higher than that of the ratio of CD4⁺/CD8⁺ （Z=4.21，P<0.001），NLR （Z=4.36，P<0.001），and SII （Z=4.48，P<0.001） for prediction alone. Conclusions The ratio of CD4⁺/CD8⁺，as well as NLR and SII levels before TACE treatment are independent factors influencing the occurrence of myelosuppression after treatment in patients with primary hepatocellular carcinoma，and are expected to be important indicators for predicting myelosuppression after hepatic artery infusion chemotherapy in patients with primary hepatocellular carcinoma.

Key words: Carcinoma，hepatocellular, T-lymphocyte subsets, Inflammatory indicators, Transcatheter arterial chemoembolization, Myelosuppression