As of 2020, hepatocellular carcinoma (HCC) is the sixth leading cause of cancer-related
deaths, making it one of the world's major public health issues. The incidence of HCC is
increasing year by year, from 14 million cases worldwide in 2012 to an estimated 22
million cases by 2030. Most HCC patients are not diagnosed until late stages, thus
missing the optimal treatment window. In recent years, comprehensive therapy with immune
targeting as the core has made breakthrough progress in the treatment of advanced liver
cancer, bringing good news to patients with advanced liver cancer. Clinical trials have
shown that immunotherapy combined with targeted therapy is effective in the treatment of
unresectable hepatocellular carcinoma. Patients have significant clinical value. However,
the therapeutic effect of immune targeting varies depending on the complex tumor
microenvironment of HCC. Therefore, there is an urgent need to establish an efficacy
evaluation model for comprehensive treatment to accurately classify and stratify patients
and select the best treatment plan.
Intratumoral T cell and B cell infiltration has been extensively studied and is
associated with good prognosis in most tumors. In recent years, tertiary lymphoid
structures (TLS) have gradually gained in-depth understanding. Tertiary lymphoid
structures are lymphatic aggregates formed at sites of inflammation in autoimmune
diseases, infections, and cancers. They can provide local antigen presentation sites and
generate effector T cells and central memory T cells, thereby providing humoral and
cellular anti-tumor specificity. Sexual immune response provides an important
microenvironment. Further studies have shown that the presence of intratumoral TLS is
associated with reduced risk of recurrence and improved survival in most solid tumors,
and mature TLS was found to be a key site of tumor-specific immune responses in
pancreatic ductal adenocarcinoma, which is consistent with immunotherapy. related to
efficacy. In addition, more and more studies have found that clinical characteristics
such as vascular endothelial growth factor (VEGF) levels are related to the effect of
comprehensive treatment of liver cancer. Studies have shown that plasma VEGF levels are
significantly related to the survival rate of patients with hepatocellular carcinoma, and
VEGF levels are important for their prognosis. Stratification has excellent clinical
value.
Therefore, this study focused on the characteristic parameters of liver cancer tumor
microenvironment such as TLS, PD-L1 expression level, and VEGF level to construct a liver
cancer comprehensive treatment efficacy evaluation model to guide the selection of
treatment options.
The predictive accuracy of the constructed model was determined by measuring the
specificity, sensitivity, and area under the receiver operating characteristic (ROC)
curve in the validation sample. Discrimination refers to the ability of a predictive
model to accurately identify patients at low and high risk for the event under
investigation, usually expressed as the area under the ROC curve. A predictive model with
an ROC of 0.75 is considered to have good discrimination, whereas an area of 0.5 is
considered equivalent to a coin toss.