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

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.

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).

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.