Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Outcomes in Patients With Unresectable Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization Plus Sorafenib

Lei Zhang; Zhi-Ping Yan; Zhong-Heng Hou; Peng Huang; Min-Jie Yang; Shuai Zhang; Shen Zhang; Shao-Hua Zhang; Xiao-Li Zhu; Cai-Fang Ni; Qiang Li

doi:10.3389/fmolb.2021.624366

Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios as Predictors of Outcomes in Patients With Unresectable Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization Plus Sorafenib

Front Mol Biosci. 2021 May 28:8:624366. doi: 10.3389/fmolb.2021.624366. eCollection 2021.

Authors

Lei Zhang¹, Zhi-Ping Yan^{2

3

4}, Zhong-Heng Hou¹, Peng Huang¹, Min-Jie Yang^{2

3

4}, Shuai Zhang¹, Shen Zhang¹, Shao-Hua Zhang⁵, Xiao-Li Zhu¹, Cai-Fang Ni¹, Qiang Li⁶

Affiliations

¹ Department of Radiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China.
² Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Shanghai Institution of Medical Imaging, Shanghai, China.
⁴ National Clinical Research Center for Interventional Medicine, Shanghai, China.
⁵ Institute of Urology, The Affiliated Luohu Hospital of Shenzhen University, Shenzhen, China.
⁶ Department of Interventional Radiology and Vascular Surgery, The Dushu Lake Affiliated Hospital of Soochow University, Suzhou, China.

Abstract

Objectives: To investigate the predictive value of inflammatory biomarkers in patients with unresectable hepatocellular carcinoma (HCC) for outcomes following the combination treatment of transarterial chemoembolization (TACE) plus sorafenib. Materials and Methods: A total of 314 (270 male and 44 female) treatment-naïve patients with unresectable HCC treated by TACE plus sorafenib between January 2011 and December 2018 were enrolled in the retrospective study. The primary outcome was overall survival (OS). The secondary outcome was progression-free survival (PFS). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were obtained within 3-7 days before the initial TACE and the median value of the NLR and PLR was considered as the cut-off value. Results: The median value of NLR and PLR was 2.42 and 100, respectively. The median OS and PFS of the entire cohort were 18.7 months (95% CI: 16.8-20.6) and 9.1 months (95% CI: 8.5-9.8), respectively. The low NLR and PLR group showed improved OS and PFS compared with the high NLR and PLR group [21.8 months (95% CI: 15.2-28.5) vs. 15.4 months (95% CI: 12.4-18.3), p < 0.0001; 21.6 months (95% CI: 15.8-27.5) vs. 14.9 months (95% CI: 11.9-17.8), p = 0.00027, respectively]. In addition, the low NLR and PLR group also provided a longer PFS than the high NLR and PLR group [10.4 months (95% CI: 8.9-12.0) vs. 8.1 months (95% CI: 7.1-9.2), p = 0.00022; 10.3 months (95% CI: 8.6-11.9) vs. 8.2 months (95% CI: 7.2-9.2), p < 0.0001, respectively]. High NLR and PLR at baseline were predictive factors of poor OS (p = 0.02 and p = 0.004) and PFS (p = 0.045 and p = 0.005). Conclusion: This study showed the prognostic value of quantitative inflammatory biomarkers in correlation with OS and PFS in unresectable HCC patients undergoing TACE plus sorafenib treatment.

Keywords: lymphocytes; neutrophils; platelet count; sorafenib; transarterial chemoembolization.