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Page 8 of 12 Yu et al. Hepatoma Res. 2025;11:29 | https://dx.doi.org/10.20517/2394-5079.2025.47

Figure 2. Area under the ROC curve (AUC) for the nomogram predictive model. ROC: Receiver operating characteristic; NLR: neutrophil-
to-lymphocyte ratio; Treg: regulatory T cell.

immunotherapy may predict the development of sirAEs . Treg cells are a small but important subset of
[15]
CD4+ T cells, which are one of the main components of the immune microenvironment. Treg cells can
regulate the strength of the body's immune response by inhibiting the activity and function of effector T
cells, so as to maintain the body's immune balance [16] . In the setting of TACE combined with
immunotherapy - where antigen release and inflammatory signals from TACE coincide with immune
checkpoint inhibition - a relatively low level of Treg cells may fail to adequately constrain the ensuing T-cell
activation. This could plausibly lead to an amplified and less controlled immune response, potentially
contributing to a higher incidence of irAEs. Treg cells in the sirAEs group were significantly less than those
in the control group (6.07 ± 4.97 vs. 9.79b ± 5.24, P < 0.05), and a low level of Treg cells was an independent
risk factor for sirAEs. Patients with Treg < 5.1 had a significantly increased risk of sirAEs. Research shows
that depleting Treg cells triggers systemic effects and leads to sirAEs . At the same time, some studies have
[17]
shown that in melanoma patients receiving immunotherapy, Treg cells in the blood of patients with sirAEs
are significantly reduced . After transient depletion of Treg cells in mice, mice are more susceptible to
[18]
sirAEs . These results are consistent with the conclusions of our study.
[19]