The neutrophil-to-lymphocyte ratio is a predictive factor for the survival of patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Chengguo Wang; Mengmeng Wang; Xiangnan Zhang; Shoujie Zhao; Jie Hu; Guohong Han; Lei Liu

doi:10.21037/atm.2020.02.113

The neutrophil-to-lymphocyte ratio is a predictive factor for the survival of patients with hepatocellular carcinoma undergoing transarterial chemoembolization

Ann Transl Med. 2020 Apr;8(8):541. doi: 10.21037/atm.2020.02.113.

Authors

Chengguo Wang¹, Mengmeng Wang², Xiangnan Zhang³, Shoujie Zhao¹, Jie Hu⁴, Guohong Han⁵, Lei Liu⁶

Affiliations

¹ Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
² Department of Drug and Equipment, Aeromedicine Identification and Training Centre of Air Force, Xi'an 710069, China.
³ Division of Scientific Research, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁴ Department of Clinical laboratory, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁵ Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China.
⁶ Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is considered as a prognostic predictor of hepatocellular carcinoma (HCC). However, its prognostic ability is still controversial. This study aimed to evaluate the prognostic value of NLR changes in HCC patients undergoing transarterial chemoembolization (TACE).

Methods: The patients who were newly diagnosed with HCC and treated with TACE in our center from July 2010 to December 2014 were enrolled in the study. The factors, including NLR, were recorded at baseline and three days and one month after TACE.

Results: A total of 380 consecutive patients were studied retrospectively. The median NLR values at baseline, 3 days and 1 month after TACE (2.4, 6.3 and 2.4 respectively), were used as the cut-off value for patient stratification. Compared with the patients in low NLR group, those with high NLR had a larger tumor size. For baseline measurement, the low NLR group showed improved overall survival (OS) compared with the high group (median OS, 27.1 vs. 15.6 months, P=0.004). There was no survival difference between the low and high NLR groups when measured at 3 days and at 1 month after TACE (P>0.05). Multivariate analysis showed that baseline NLR >2.4 was an independent prognostic predictor of poor OS. There was significant survival difference between the normal NLR group and the high or increased NLR group, with a median OS of 29.1 and 19.1 months, respectively (P=0.023).

Conclusions: The dynamic changes of baseline NLR are significantly associated with OS in HCC patients treated with TACE, and as a result patient selection and prognostic prediction may be refined.

Keywords: Hepatocellular carcinoma (HCC); neutrophil-to-lymphocyte ratio (NLR); overall survival (OS); prognosis; transarterial chemoembolization (TACE).