Predictive Value of Peripheral Blood Follicular Helper T Cells for Short-term Prognosis in Patients with Hepatocellular Carcinoma Treated with Immune Checkpoint Inhibitors

Peripheral blood follicular helper T cells (Tfh) are essential in humoral immunity; however, their prognostic significance in hepatocellular carcinoma (HCC) patients treated with immune checkpoint inhibitors (ICIs) is not well understood. This study aimed to evaluate the predictive value of Tfh cells for short-term prognosis in 200 HCC patients undergoing ICIs. A retrospective analysis categorized patients based on their clinical outcomes at six months post-treatment: those demonstrating improvement were classified as having a favorable prognosis (n=86), while those with no remission, deterioration, or death were classified as having a poor prognosis (n=114). Key prognostic factors assessed included C-reactive protein (CRP), interleukin-6 (IL-6), Tfh cell counts, and combination therapy. Significant associations were identified between prognosis and CRP, IL-6, Tfh cell counts, and combination therapy. Multivariate analysis revealed these factors as independent predictors of short-term prognosis, explaining 78.3% of the variance. The area under the curve (AUC) for Tfh cells was 0.902 (95% CI: 0.8567-0.9477), with 100% sensitivity and 80.70% specificity at a cut-off of 1.995. Patients with elevated Tfh levels (≥1.995, n=93) had a median overall survival (OS) of 5 months, significantly earlier than those with lower levels (<1.995, n=107), whose median OS was not reached. Tfh cells are independent predictors of short-term prognosis in HCC patients receiving ICIs. Reduced Tfh levels correlate with improved outcomes, providing crucial insights for clinical decision-making.