Objective:

To investigate the characteristics and functional status of LAG-3, CD8, and PD-1 in the immune microenvironment of hepatocellular carcinoma (HCC) patients and evaluate their prognostic value for the efficacy of anti-PD-1 antibodies combined with Lenvatinib.

Approach:

• Study Design: A retrospective study involving 77 HCC patients treated with Lenvatinib and anti-PD-1 antibodies from January 2018 to June 2023.
• Response Assessment: Treatment responses were categorized as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD).
• Statistical Analysis: Multivariate Cox regression analysis was performed to identify independent prognostic factors for overall survival (OS) and progression-free survival (PFS).

Key Findings:

• Age stratification (<60 years vs ≥60 years), cirrhosis status, and ECOG performance status were associated with treatment response.
• High pan-immune-inflammation value (PIV) and low LAG-3+ cell counts were independent prognostic factors for overall survival (OS) with hazard ratios of 9.239 and 0.190, respectively.
• Low albumin levels and high neutrophil-to-lymphocyte ratio (NLR) were independent prognostic factors for progression-free survival (PFS) with hazard ratios of 0.196 and 2.894, respectively.

Interpretation:

LAG-3 may serve as a prognostic factor for survival benefits in HCC patients receiving Lenvatinib plus anti-PD-1 antibodies.

Limitations:

• Retrospective design may introduce selection bias.
• Limited sample size may affect the generalizability of findings.

Conclusion:

LAG-3 is discussed as a potential prognostic factor for HCC patients treated with Lenvatinib and anti-PD-1 antibodies.