Dynamics changes of spleen volume predict survival outcomes in unresectable hepatocellular carcinoma treated with tislelizumab plus lenvatinib.
Authors
Affiliations (2)
Affiliations (2)
- Department of Hepatobiliary, Pancreatic and Splenic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No.600 Tianhe Road, Tianhe District Guangzhou, Guangzhou, 510000, China.
- Department of Hepatobiliary, Pancreatic and Splenic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, No.600 Tianhe Road, Tianhe District Guangzhou, Guangzhou, 510000, China. [email protected].
Abstract
Dynamic changes in spleen volume (SpV) may reflect immune and hemodynamic alterations in hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic significance of SpV dynamics in patients with unresectable HCC (uHCC) treated with tislelizumab plus lenvatinib. We retrospectively analyzed 103 patients with uHCC treated with tislelizumab plus lenvatinib between June 2021 and June 2025. SpV was measured on contrast-enhanced CT at baseline and approximately 3 months post-treatment using AI-assisted segmentation with manual correction. The absolute SpV change (ΔSpV) and monthly SpV change rate were calculated. The optimal cut-off values were identified via maximally selected rank statistics. Survival outcomes were assessed using Kaplan-Meier analysis and Cox regression models. Post-treatment SpV increase was observed in 65% of patients and was associated with shorter progression-free survival (PFS). Both ΔSpV and SpV change rate were independent predictors of PFS (HR for ΔSpV: 1.005, P = 0.01; HR for change rate: 1.02, P < 0.00). Cut-off values of 23.81 cm<sup>3</sup> (ΔSpV) and 8.24 cm<sup>3</sup>/month (change rate) significantly stratified patients into distinct PFS risk groups (11.6 vs. 25.5 months, both P < 0.05). Three-month landmark analysis revealed that a SpV change rate ≥ 8.24 cm<sup>3</sup>/month predicted significantly shorter PFS within the first 3 months (P = 0.039), while a ΔSpV ≥ 23.81 cm<sup>3</sup> was associated with significantly poorer PFS after 3 months of treatment (P = 0.040). Baseline portal hypertension and larger tumor size correlated with greater SpV increases. SpV dynamics provide a noninvasive imaging biomarker for identifying uHCC patients at elevated risk of progression during tislelizumab plus lenvatinib therapy. Incorporating these volumetric metrics into routine imaging may enhance prognostic assessment and guide risk-adapted patient management.