治疗前s指数作为同步结直肠肝转移患者治疗反应和生存的预后指标：一项回顾性多中心研究

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2025-08-14 DOI:10.1016/j.ejso.2025.110371

Yiqiao Deng , Yuan Li , Rui Zhang , Zhijie Wang , Rui Guo , Xinyu Bi , Jianjun Zhao , Jianguo Zhou , Zhiyu Li , Rui Zhang , Qichen Chen , Hong Zhao

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引用次数: 0

摘要

背景：伴有同步性结直肠癌肝转移（CRLM）的患者在接受全身治疗或切除后，往往面临预后不佳的问题。本研究探讨了治疗前s指数（一种可靠的非侵入性肝纤维化指标）对同步CRLM患者预后的预测价值。方法本研究包括两组同步CRLM患者：一组接受切除，另一组接受不可切除的CRLM全身治疗。通过血液样本评估治疗前s指数水平。将患者分为高s指数组和低s指数组，并对结果进行比较：无进展生存期（PFS），切除人群的早期术后复发和肝转移纤维化，以及全身治疗人群的治疗反应。采用多重免疫组化/免疫荧光（mIHC/IF）技术研究肝转移灶中免疫抑制性t细胞亚群的分布。结果在同步行切除的CRLM患者（n = 1000）中，术前s指数高的患者在术前（HR = 1.556, 95% CI: 1.255 ~ 1.929; P < 0.001）和经iptwr校正的Cox比例风险回归分析（iptwr校正HR = 1.439, 95% CI: 1.094 ~ 1.894; P = 0.036）均表现出较差的PFS。调整前后，高s指数患者的早期复发风险也较高（OR = 1.556, 95% CI: 1.255-1.929, P < 0.001；调整iptwr后OR = 1.439, 95% CI: 1.094-1.894, P = 0.009）。在接受系统治疗的同步CRLM患者（n = 123）中，在多变量分析中，高治疗前s指数（OR = 34.691, P = 0.005）是疾病进展的显著预测因子。此外，s指数检测肝转移灶纤维化的AUC为0.814 (95% CI: 0.762-0.866, P < 0.001)，特异性为0.928。mIHC/IF分析显示，高s指数组肝转移灶中抑制性T细胞，尤其是CD4+PD1+ T细胞和CD4+FOXP3+ T细胞显著升高。结论本研究为同步CRLM患者接受切除或系统治疗的治疗前s指数与预后的相关性提供了有价值的证据。此外，它强调了高s指数与肝转移中纤维化的存在以及肿瘤中免疫抑制性T细胞的更多浸润之间的显著关联。

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Pre-treatment S-index as a promising prognostic indicator of treatment response and survival in patients with synchronous colorectal liver metastases: A retrospective multi-center study

Background

Patients with synchronous colorectal cancer liver metastasis (CRLM) often face sub-optimal outcomes from systemic therapy or resection. This study investigates the prognostic value of the pre-treatment S-index, a reliable non-invasive marker for liver fibrosis, for outcomes in synchronous CRLM patients.

Methods

This study included two populations of patients with synchronous CRLM: one population undergoing resection and another population receiving systemic therapy for unresectable CRLM. Pre-treatment S-index levels were assessed from blood samples. Patients were categorized into high and low S-index groups, and comparisons were made regarding outcomes: progression-free survival (PFS), early post-operative recurrence and fibrosis in liver metastases in the resection population, and treatment response in the systemic therapy population. Multiplex immunohistochemistry/immunofluorescence (mIHC/IF) was used to investigate the distribution of immunosuppressive T-cell subsets in liver metastases.

Results

For synchronous CRLM patients receiving resection (n = 1000), patients with high preoperative S-index demonstrated significantly worse PFS both before (HR = 1.556, 95 % CI: 1.255–1.929; P < 0.001) and after IPTW-adjusted Cox proportional hazards regression analysis (IPTW-adjusted HR = 1.439, 95 % CI: 1.094–1.894; P = 0.036). High S-index patients also exhibited an elevated risk of early recurrence, both before and after adjustment (OR = 1.556, 95 % CI: 1.255–1.929, P < 0.001; IPTW-adjusted OR = 1.439, 95 % CI: 1.094–1.894, P = 0.009). For synchronous CRLM patients receiving system therapy (n = 123), a high pre-treatment S-index (OR = 34.691, P = 0.005) was a significant predictor of progression disease in multivariate analyses. Further, the S-index showed an AUC of 0.814 (95 %CI: 0.762–0.866, P < 0.001) for detecting fibrosis in liver metastases, with a specificity of 0.928. mIHC/IF analysis revealed that inhibitory T cells, especially CD4⁺PD1⁺ T cells and CD4⁺FOXP3⁺ T cells, were significantly elevated in the liver metastases of the high S-index group.

Conclusion

This study contributed valuable evidence regarding pre-treatment S-index for association with outcomes among synchronous CRLM patients receiving resection or system therapy. Furthermore, it underscores a significant association between a high S-index and the presence of fibrosis in liver metastases, as well as more infiltration of immunosuppressive T cells in the tumor.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.