Low CT-derived vertebral attenuation as a prognostic factor in hepatocellular carcinoma patients treated with immune checkpoint inhibitors
- 1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- 2Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine
- 3Hubei Key Laboratory of Molecular Imaging
Abstract
Background: Computed tomography (CT)-derived vertebral attenuation has been recognized as an indicator of prognosis for patients undergoing tumor removal, liver transplant, or transcatheter arterial chemoembolization (TACE) therapy, but similar research has not been reported in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs). This study aims to explore the prognostic value of CT-derived vertebral attenuation in HCC patients treated with ICIs.
Methods: This retrospective study included HCC patients who received ICI treatment at Wuhan Union Hospital between July 2020 and March 2024. CT-derived vertebral attenuation was assessed by measuring mean Hounsfield unit (HU) values in the center of the first lumbar vertebra (L1) on non-contrast CT scans. Based on the optimal cutoff value derived from X-tile software, patients were classified into the CT-derived L1 attenuation-low group (≤100 HU) and the CT-derived L1 attenuation-high group (>100 HU). A comparison of the baseline characteristics of the two groups was made, followed by a propensity score matching (PSM) analysis to balance the variables. The objective response rate (ORR) and disease control rate (DCR) were calculated for both groups, and Kaplan-Meier survival curves and Cox regression models were used to analyze overall survival (OS) and progression-free survival (PFS).
Results: The cohort consisted of 357 patients, divided into the L1 attenuation-low group (n = 112) and the L1 attenuation-high group (n = 245). Among all patients, 30.0% (107/357) achieved complete or partial response. After PSM analysis, both groups contained 91 patients. The L1 attenuation-low group had shorter OS (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.15–2.60; P = 0.008) and PFS (HR, 1.47; 95% CI, 1.04–2.08; P = 0.030) than the L1 attenuation-high group.
Conclusion: CT-derived L1 attenuation can stratify survival risk for HCC patients undergoing ICI treatment.
Related
- Longitudinal Changes in CT-Derived Vertebral Trabecular Attenuation and Psoas Muscle Density After Liver Transplantation for Hepatocellular Carcinoma.
- Mechanisms of Resistance and Immune-Related Adverse Events Associated with Immune Checkpoint Inhibitors in Hepatocellular Carcinoma: A Narrative Review.
- Efficacy and Safety of Sequential Radiotherapy and Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Single-Center PSM Retrospective Cohort Study.
- Conversion Surgery After HAIC-Based Combination Therapy with Targeted Therapy and Immune Checkpoint Inhibitors for Initially Unresectable Hepatocellular Carcinoma: A Retrospective Cohort Study
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BibTeX
@article{jiang2026ctderived,
title = {{Low CT-derived vertebral attenuation as a prognostic factor in hepatocellular carcinoma patients treated with immune checkpoint inhibitors}},
author = {Shanshan Jiang and Yi Ren and Yuyang Wang and Yi Li and Lianwei Miao and Weiwei Liu and Guofeng Zhou},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1971063},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1971063/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low CT-derived vertebral attenuation as a prognostic factor in hepatocellular carcinoma patients treated with immune checkpoint inhibitors
AU - Shanshan Jiang
AU - Yi Ren
AU - Yuyang Wang
AU - Yi Li
AU - Lianwei Miao
AU - Weiwei Liu
AU - Guofeng Zhou
PY - 2026
DA - 2026/10/07
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1971063
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1971063/full
AB - Background: Computed tomography (CT)-derived vertebral attenuation has been recognized as an indicator of prognosis for patients undergoing tumor removal, liver transplant, or transcatheter arterial chemoembolization (TACE) therapy, but similar research has not been reported in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs). This study aims to explore the prognostic value of CT-derived vertebral attenuation in HCC patients treated with ICIs. Methods: This retrospective study included HCC patients who received ICI treatment at Wuhan Union Hospital between July 2020 and March 2024. CT-derived vertebral attenuation was assessed by measuring mean Hounsfield unit (HU) values in the center of the first lumbar vertebra (L1) on non-contrast CT scans. Based on the optimal cutoff value derived from X-tile software, patients were classified into the CT-derived L1 attenuation-low group (≤100 HU) and the CT-derived L1 attenuation-high group (>100 HU). A comparison of the baseline characteristics of the two groups was made, followed by a propensity score matching (PSM) analysis to balance the variables. The objective response rate (ORR) and disease control rate (DCR) were calculated for both groups, and Kaplan-Meier survival curves and Cox regression models were used to analyze overall survival (OS) and progression-free survival (PFS). Results: The cohort consisted of 357 patients, divided into the L1 attenuation-low group (n = 112) and the L1 attenuation-high group (n = 245). Among all patients, 30.0% (107/357) achieved complete or partial response. After PSM analysis, both groups contained 91 patients. The L1 attenuation-low group had shorter OS (hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.15–2.60; P = 0.008) and PFS (HR, 1.47; 95% CI, 1.04–2.08; P = 0.030) than the L1 attenuation-high group. Conclusion: CT-derived L1 attenuation can stratify survival risk for HCC patients undergoing ICI treatment.
SN - 2234-943X
ER -