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中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 355 -361. doi: 10.3877/cma.j.issn.2095-3232.2026.03.009

临床研究

全身炎症反应指数对晚期肝癌患者TACE联合靶向免疫治疗预后的预测价值
黄思捷1, 张惠勇1, 郭小辉2, 徐成润1,†()   
  1. 1　363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）感染科
    2　363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）重症医学科
  • 收稿日期:2025-11-03 出版日期:2026-06-10
  • 通信作者: 徐成润
  • 基金资助:
    福建省自然科学基金(2024J011583)

Prognostic value of systemic inflammatory response index in patients with advanced liver cancer after TACE combined with targeted immunotherapy

Sijie Huang1, Huiyong Zhang1, Xiaohui Guo2, Chengrun Xu1,†()   

  1. 1 Department of Infectious Diseases, the 909th Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
    2 Department of Critical Care Medicine, the 909th Hospital (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
  • Received:2025-11-03 Published:2026-06-10
  • Corresponding author: Chengrun Xu
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引用本文：

黄思捷, 张惠勇, 郭小辉, 徐成润. 全身炎症反应指数对晚期肝癌患者TACE联合靶向免疫治疗预后的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 355-361.

Sijie Huang, Huiyong Zhang, Xiaohui Guo, Chengrun Xu. Prognostic value of systemic inflammatory response index in patients with advanced liver cancer after TACE combined with targeted immunotherapy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(03): 355-361.

目的

探讨全身炎症反应指数（SIRI）对晚期肝癌患者TACE联合靶向免疫治疗预后的预测价值。

方法

回顾性分析2020年1月至2023年12月厦门大学附属东南医院收治的128例晚期肝癌患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男73例，女55例；年龄47~69岁，中位年龄58岁。所有患者均接受TACE联合靶向免疫治疗，根据治疗效果绘制ROC曲线确定SIRI最佳界值，将128例患者根据最佳界值分为高SIRI组（44例）和低SIRI组（84例）。两组患者临床特征分析采用χ2检验或Fisher确切概率法，总生存期（OS）和无进展生存期（PFS）分析采用Kaplan-Meier法。采用Cox风险比例模型分析晚期肝癌患者影响因素。

结果

128例晚期肝癌患者中位OS 17.5个月、中位PFS 8.5个月。依据肿瘤疗效评价标准，客观缓解率（ORR）为28.1%（36/128），其中7.8%（10/128）完全缓解（CR），20.3%（26/128）部分缓解（PR）。SIRI对治疗效果有预测价值，AUC为0.891，95%CI为0.828~0.953，灵敏度为0.806，特异度为0.837，SIRI最佳界值为1.10。高SIRI患者肿瘤≥ 10 cm、肿瘤≥3个、血管侵犯、BCLC分期C期、治疗无缓解发生率明显高于低SIRI患者（χ2=7.397，4.127，5.570，4.987，9.318；P<0.05）。Cox多因素分析显示，血管侵犯（HR=0.681，95%CI：0.467~0.994）、因药物不良反应导致停药（HR=0.349，95%CI：0.135~0.902）、SIRI（HR=0.422，95%CI：0.285~0.625）是晚期肝癌患者PFS独立影响因素；AFP（HR=1.492，95%CI：1.097~2.454）、SIRI（HR=0.344，95%CI：0.224~0.530）是晚期肝癌患者OS独立影响因素。随访时间5~26个月，中位随访时间17.5个月。高SIRI组和低SIRI组中位OS分别为14.5、18.5个月，差异有统计学意义（χ2=24.091，P<0.001）。两组中位PFS分别为4.5、9.5个月，差异亦有统计学意义（χ2=30.577，P<0.001）。

结论

SIRI对晚期肝癌患者TACE联合靶向免疫治疗效果有预测价值，是患者PFS和OS独立危险因素。高SIRI与肿瘤≥ 10 cm、肿瘤≥3个、血管侵犯、BCLC分期C期、治疗无缓解相关。

关键词: 全身炎症反应指数, 进展期肝癌, 肝动脉化疗栓塞, 靶向治疗, 免疫治疗
Objective

To explore the prognostic value of systemic inflammatory response index (SIRI) in patients with advanced liver cancer after TACE combined with targeted immunotherapy.

Methods

Clinical data of 128 patients with advanced liver cancer admitted to Southeast Hospital affiliated to Xiamen University from January 2020 to December 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 73 patients were male and 55 female, aged from 47 to 69 years, with a median age of 58 years. All patients received TACE combined with targeted immunotherapy. According to the therapeutic effect, the receiver operating characteristic (ROC) curve was drawn to determine the optimal threshold value of SIRI. 128 patients were divided into the high SIRI (n=44) and low SIRI groups (n=84) according to the optimal threshold value of SIRI. Clinical characteristics of all patients in two groups were analyzed by Chi-square test or Fisher's exact probability test, and the overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method. The influencing factors of patients with advanced liver cancer were identified by Cox proportional hazards model.

Results

Among 128 patients with advanced liver cancer, the median OS was 17.5 months and the median PFS was 8.5 months. According to the Response Evaluation Criteria in Solid Tumors (RECIST), the objective response rate (ORR) was 28.1%(36/128), 7.8%(10/128) for complete response (CR) and 20.3%(26/128) for partial response (PR). SIRI had predictive value for clinical efficacy. The area under the ROC curve (AUC) was 0.891 (95%CI: 0.828-0.953), the sensitivity was 0.806, the specificity was 0.837, and the optimal threshold value of SIRI was 1.10, respectively. The incidence rates of tumor diameter≥10 cm, the number of tumor≥3, vascular invasion, BCLC stage C and no remission post-treatment in patients with high SIRI were significantly higher than those in patients with low SIRI (χ2=7.397, 4.127, 5.570, 4.987, 9.318; all P<0.05). Multivariate Cox analysis showed that vascular invasion (HR=0.681, 95%CI: 0.467-0.994), drug withdrawal due to adverse drug reactions (HR=0.349, 95%CI: 0.135-0.902), SIRI(HR=0.422, 95%CI: 0.285-0.625) were the independent influencing factors of PFS in patients with advanced liver cancer. AFP(HR=1.492, 95%CI: 1.097-2.454) and SIRI (HR=0.344, 95%CI: 0.224-0.530) were the independent influencing factors of OS in patients with advanced liver cancer. The follow-up time was 5-26 months, and the median follow-up time was 17.5 months. The median OS in the high and low SIRI groups was 14.5 and 18.5 months, and the difference was statistically significant (χ2=24.091, P<0.001). The median PFS between two groups was 4.5 and 9.5 months, and the difference was also statistically significant (χ2=30.577, P<0.001).

Conclusions

SIRI possesses predictive value for clinical efficacy of TACE combined with targeted immunotherapy in patients with advanced liver cancer, and it is an independent risk factor for PFS and OS. High SIRI is associated with tumor diameter≥10 cm, number of tumor≥3, vascular invasion, BCLC stage C and no remission post-treatment.

Key words: Systemic inflammatory response index, Advanced liver cancer, Hepatic artery chemoembolization, Targeted therapy, Immunotherapy
图1 SIRI预测晚期肝癌治疗效果ROC曲线分析 注：SIRI为全身炎症反应指数
表1 不同SIRI晚期肝癌患者临床特征比较（例）
分组 高SIRI组 低SIRI组 χ2值 P值
年龄≥60岁 22 40 0.066 0.798
男性 28 45 1.194 0.275
糖尿病 6 11 0.007 0.932
高血压 9 13 0.503 0.487
乙肝 21 51 1.979 0.195
肝硬化 9 19 0.079 0.778
Child-Pugh分级A级 27 46 0.514 0.474
ALB<35 g/L 6 12 0.010 0.920
TB≥17.1 mmol/L 5 12 0.214 0.644
AFP≥400 μg/L 33 73 2.875 0.090
肿瘤部位 2.988 0.225
左肝 13 18
右肝 15 42
左、右肝 16 24
肿瘤直径≥10 cm 32 40 7.397 0.007
肿瘤个数≥3个 35 52 4.127 0.042
血管侵犯 33 45 5.570 0.018
BCLC分期C期 28 36 4.987 0.026
因药物不良反应导致停药 4 2 - 0.180
治疗无缓解 39 53 9.318 0.002
表2 晚期肝癌患者PFS影响因素Cox回归分析
变量 单因素分析 多因素分析
HR(95%CI) P值 HR(95%CI) P值
ALB<35 g/L 1.928(1.007~3.689) 0.047 1.753(0.983~3.126) 0.057
血管侵犯 0.629(0.416~0.949) 0.027 0.681(0.467~0.994) 0.046
因药物不良反应导致停药 0.254(0.084~0.767) 0.015 0.349(0.135~0.902) 0.030
SIRI<1.10 0.436(0.269~0.707) 0.001 0.422(0.285~0.625) <0.001
表3 晚期肝癌患者OS影响因素Cox回归分析
变量 单因素分析 多因素分析
HR(95%CI) P值 HR(95%CI) P值
ALB<35 g/L 1.920(1.003~3.674) 0.049 0.692(0.416~1.154) 0.158
AFP≥400 μg/L 1.794(1.008~3.191) 0.047 1.492(1.097~2.454) 0.048
SIRI<1.10 0.272(0.163~0.455) <0.001 0.344(0.224~0.530) <0.001
图2 两组患者OS和PFS的Kaplan-Meier生存曲线 注：SIRI为全身炎症反应指数
[1]
中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(4): 407-449. DOI: 10.3877/cma.j.issn.2095-3232.2024.04.001.
[2]
Maki H, Hasegawa K. Advances in the surgical treatment of liver cancer[J]. BioScience Trends, 2022, 16(3): 178-188. DOI: 10.5582/bst.2022.01245.
[3]
Jiang Y, Dong X, Zhang Y, et al. Navigating the complexities: challenges and opportunities in conversion therapy for advanced hepatocellular carcinoma[J]. Clin Exp Med, 2025, 25(1): 169. DOI: 10.1007/s10238-025-01698-9.
[4]
Caliskan Yildirim E, Ergun Y. Advancing hepatocellular carcinoma treatment with hepatic arterial infusion chemotherapy[J]. World J Gastrointest Oncol, 2024, 16(12): 4757-4761. DOI: 10.4251/wjgo.v16.i12.4757.
[5]
Hakoda H, Ichida A, Hasegawa K. Advances in systemic therapy leading to conversion surgery for advanced hepatocellular carcinoma[J]. BioScience Trends, 2024, 18(6): 525-534. DOI: 10.5582/bst.2024.01372.
[6]
Li J, Shi HY, Zhou M. Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer[J]. World J Gastrointest Surg, 2023, 15(11): 2445-2455. DOI: 10.4240/wjgs.v15.i11.2445.
[7]
Yu L, Zheng S, Yang J, et al. Association between the systemic immune inflammation index and recurrence or metastasis after interventional therapy in patients with primary liver cancer-a retrospective cohort study[J]. J Gastrointest Oncol, 2023, 14(2): 780-788. DOI: 10.21037/jgo-23-104.
[8]
Tang C, Zhang M, Jia H, et al. The systemic inflammation response index (SIRI) predicts survival in advanced non-small cell lung cancer patients undergoing immunotherapy and the construction of a nomogram model[J]. Front Immunol, 2024, 15: 1516737. DOI: 10.3389/fimmu.2024.1516737.
[9]
Wu Q, Zhao H. Prognostic and clinicopathological role of pretreatment systemic inflammation response index (SIRI) in gastric cancer: a systematic review and meta-analysis[J]. World J Surg Oncol, 2024, 22(1): 333. DOI: 10.1186/s12957-024-03602-3.22(1): 333.
[10]
Prijovic N, Acimovic M, Santric V, et al. Predictive value of inflammatory and nutritional indexes in the pathology of bladder cancer patients treated with radical cystectomy[J]. Curr Oncol, 2023, 30(3): 2582-2597. DOI: 10.3390/curroncol30030197.
[11]
Lencioni R, Llovet J. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma[J]. Semin Liver Dis, 2010, 30(1): 52-60. DOI: 10.1055/s-0030-1247132.
[12]
蔡建强, 赵宏, 陈晓. 肝癌综合治疗新格局[J]. 中华消化外科杂志, 2024, 23(2): 204-208. DOI: 10.3760/cma.j.cn115610-20231208-00243.
[13]
Zou W, Fang Z, Feng Y, et al. Transcriptomic and genomic characteristics of intrahepatic metastases of primary liver cancer[J]. BMC Cancer, 2024, 24(1): 672. DOI: 10.1186/s12885-024-12428-x.
[14]
中国抗癌协会肝癌专业委员会转化治疗协作组. 肝癌转化治疗中国专家共识 (2021版)[J]. 中国实用外科杂志, 2021, 41(6): 618-632. DOI: 10.3760/cma.j.cn115610-20210512-00223.
[15]
Yi C, Chen L, Lin Z, et al. Lenvatinib Targets FGF Receptor 4 to Enhance Antitumor Immune Response of Anti-Programmed Cell Death-1 in HCC[J]. Hepatology, 2021, 74(5): 2544-2560. DOI: 10.1002/hep.31921.
[16]
Tao M, Han J, Shi J, et al. Application and resistance mechanisms of lenvatinib in patients with advanced hepatocellular carcinoma[J]. J Hepatocell Carcinoma, 2023, 10: 1069-1083. DOI: 10.2147/jhc.s411806.
[17]
Wu JY, Yin ZY, Bai YN, et al. Lenvatinib combined with anti-PD-1 antibodies plus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: a multicenter retrospective study[J]. J Hepatocell Carcinoma, 2021, 8: 1233-1240. DOI: 10.2147/jhc.s332420.
[18]
Wang MD, Xu XJ, Wang KC, et al. Conversion therapy for advanced hepatocellular carcinoma in the era of precision medicine: current status, challenges and opportunities[J]. Cancer Sci, 2024, 115(7): 2159-2169. DOI: 10.1111/cas.16194.
[19]
Zhang J, Chen C, Xia Z, et al. Prognostic analysis of systemic antitumor therapy in young patients with advanced liver cancer: a cohort study[J]. Oncol Lett, 2024, 28(3): 410. DOI: 10.3892/ol.2024.14544.
[20]
Sun Y, Shi G, Yang J, et al. Deciphering the heterogeneity and plasticity of the tumor microenvironment in liver cancer provides insights for prognosis[J]. Front Pharmacol, 2025, 16: 1495280. DOI: 10.3389/fphar.2025.1495280.
[21]
Zhou M, Zhao W, Zhang X, et al. Nicotinamide metabolism affects the prognosis of hepatocellular carcinoma by influencing the tumor microenvironment[J]. Cytokine, 2025, 191: 156939. DOI: 10.1016/j.cyto.2025.156939.
[22]
Lv Z, Feng HY, Wang T, et al. Preoperative systemic inflammation response index indicates poor prognosis in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus[J]. Urol Oncol Semin Orig Investig, 2022, 40(4): 167. e9-167. e19. DOI: 10.1016/j.urolonc.2021.11.030.
[23]
Feng J, Wang Q. Correlation of systemic immune-inflammatory response index with clinical data in patients with malignant ovarian tumor[J]. Am J Transl Res, 2023, 15(5): 3309-3317.
[24]
Menyhart O, Fekete JT, Győrffy B. Inflammation and colorectal cancer: a meta-analysis of the prognostic significance of the systemic immune–inflammation index (SII) and the systemic inflammation response index (SIRI)[J]. Int J Mol Sci, 2024, 25(15): 8441. DOI: 10.3390/ijms25158441.
[25]
许文超, 赵宇鹏, 郭俊超. 中性粒细胞与肿瘤肝转移: 从基础到临床[J]. 中华实验外科杂志, 2024, 41(11): 2431-2434. DOI: 10.3760/cma.j.cn421213-20240429-01082.
[26]
Sabit H, Arneth B, Abdel-Ghany S, et al. Beyond cancer cells: how the tumor microenvironment drives cancer progression[J]. Cells, 2024, 13(19): 1666. DOI: 10.3390/cells13191666.13(19): 1666.
[27]
宫昕宇, 李强, 李川, 等. 肿瘤浸润淋巴细胞(TILs)免疫疗法及其在肺癌治疗中应用的研究进展[J]. 现代肿瘤医学, 2025, 33(4): 712-718. DOI: 10.3969/j.issn.1672-4992.2025.04.025.
[28]
Su X, Zhang M, Zhu H, et al. Mechanisms of T-cell depletion in tumors and advances in clinical research[J]. Biol Proced Online, 2025, 27(1): 5. DOI: 10.1186/s12575-025-00265-6.
[29]
严征远, 张恒, 尹光平. 术前纤维蛋白原与白蛋白比值联合全身炎症反应指数对可切除胃癌患者预后的评估价值[J/OL]. 中华普通外科学文献(电子版), 2020, 14(4): 266-270. DOI: 10.3877/cma.j.issn.1674-0793.2020.04.007.
[30]
杜君, 段鹏强, 张超, 等. 术前全身炎症反应指数对中高危非肌层浸润性膀胱癌预后的影响[J]. 中国肿瘤临床, 2023, 50(16): 829-833. DOI: 10.12354/j.issn.1000-8179.2023.20230616.
[31]
Hayama T, Ochiai H, Ozawa T, et al. High systemic inflammation response index (SIRI) level as a prognostic factor for colorectal cancer patients after curative surgery: a single-center retrospective analysis[J]. Sci Rep, 2025, 15: 1008. DOI: 10.1038/s41598-024-84991-z.
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[15] 陆飞, 邓朗朗, 刘江江, 张煜, 冯伟, 马海涛. 局部进展期食管鳞状细胞癌患者新辅助免疫联合化疗前后体成分变化与围手术期结局的相关性分析[J/OL]. 中华胸部外科电子杂志, 2026, 13(01): 36-48.
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