Peripheral PD-1⁺ T cell signatures predict immunotherapy response and survival in hepatobiliary cancers.

[BACKGROUND] Immune checkpoint inhibitors (ICIs) have shown efficacy in hepatobiliary malignancies; however, reliable biomarkers for predicting treatment response remain limited. Peripheral PD-1⁺ T cells, which reflect both T-cell exhaustion and reinvigoration, may serve as novel immune correlates of clinical benefit.

[METHODS] We prospectively enrolled 99 patients with advanced hepatocellular carcinoma (HCC) or biliary tract cancer (BTC) who received ICIs at Peking Union Medical College Hospital between December 2023 and December 2024. Peripheral blood was collected at baseline and during treatment for flow cytometric quantification of PD-1⁺ T-cell subsets. Patients were randomly divided into a training cohort (n=69) and a validation cohort (n=30). Survival outcomes were analyzed using the Kaplan-Meier method. Baseline predictors were identified by least absolute shrinkage and selection operator (LASSO) regression, followed by nomogram construction.

[RESULTS] Responders exhibited significantly longer progression-free survival (PFS; 16.4 vs. 3.5 months, p<0.001) and overall survival (OS; not reached vs. 10.8 months, p<0.001) than non-responders. Higher baseline CD3⁺PD-1⁺ T-cell percentages (32.8% vs. 24.5%, p<0.001) and lower neutrophil-to-lymphocyte ratios (NLR, p=0.002) characterized responders. LASSO regression identified cirrhosis, CD3⁺PD-1⁺ T-cell percentage, and NLR as independent predictors (AUC 0.846 training; 0.670 validation). Longitudinal analysis showed that decreased PD-1⁺ T-cell levels post-treatment correlated with clinical response, while a post-/pre-treatment CD8⁺PD-1⁺ T-cell ratio above 0.07 predicted inferior PFS.

[CONCLUSIONS] Baseline and dynamic circulating PD-1⁺ T-cell profiles robustly predict ICI response and survival in hepatobiliary cancers, supporting their potential as noninvasive biomarkers for individualized immunotherapy.