Abstract
BACKGROUND: The study explores the incidence and clinical features of immune-related liver injury (irLI) in hepatocellular carcinoma (HCC) patients compared to those with other malignancies receiving immune checkpoint inhibitors (ICIs). METHODS: A retrospective analysis was conducted on patients treated with ICIs at Beijing Friendship Hospital. Individuals who experienced liver injury consistent with the criteria specified in the Common Terminology Criteria for Advanced Event version 5.0 for irLI were included in the study. The cohort was divided into an HCC group and a non-HCC malignancy group. HCC patients were further classified into three subgroups based on liver injury: no injury, irLI, or non-immune-related liver injury. Data on demographics, laboratory results, and mortality rates were compared. RESULTS: The study included 292 hCC patients and 1248 patients with other malignancies. Both groups underwent a similar number of ICIs cycles (p=0.237). Liver injury was more common in HCC patients [98 (33.6%) vs 288 (23.1%), p<0.001], but the irLI incidence was comparable between the groups [17 (5.8%) vs 62 (5.0%), p=0.556]. Tumor progression-related liver injury was higher in HCC patients (12.0%) compared to other malignancies (4.6%). Mortality rates showed no significant differences between groups. CONCLUSION: HCC patients with underlying liver disease are more prone to liver injury during ICIs therapy, mainly due to tumor progression rather than irLI.