Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, UK.
Transl Res. 2012 Aug;160(2):146-52. doi: 10.1016/j.trsl.2012.01.011. Epub 2012 Jan 30.
Transarterial chemoembolization (TACE) is the preferred treatment for unresectable, intermediate-stage hepatocellular carcinoma (HCC). However, survival after TACE can be highly variable, suggesting the need for more accurate patient selection to improve therapeutic outcome. We have explored the prognostic ability of the blood neutrophil-to-lymphocyte ratio (NLR), a biomarker of systemic inflammation, as a predictor of survival after TACE. Fifty-four patients with a diagnosis of HCC eligible for TACE were selected. Clinicopathologic variables were collected, including demographics, tumor staging, liver functional reserve, and laboratory variables. Dynamic changes in the NLR before and after TACE were studied as predictors of survival using both a univariate and multivariate Cox regression model. Patients in whom the NLR remained stable or normalized after TACE showed a significant improvement in overall survival of 26 months compared with patients showing a persistently abnormal index (P = 0.006). Other predictors of survival on univariate analysis were Cancer of the Liver Italian Program score (P = 0.05), intrahepatic spread (P = 0.01), tumor diameter > 5 cm (P = 0.02), > 1 TACE (P = 0.01), alpha-fetoprotein ≥ 400 (P = 0.002), and radiologic response to TACE (P < 0.001). Improved NLR after TACE (P = 0.03) and radiologic response after TACE (P = 0.003) remained independent predictors of survival on multivariate analysis. Changes in alpha-fetoprotein after treatment did not predict survival. Patients with a persistently increased NLR have a worse outcome after TACE. NLR is a simple and universally available stratifying biomarker that can help identify patients with a significant survival advantage after TACE.
经动脉化疗栓塞（TACE）是不可切除的中期肝细胞癌（HCC）的首选治疗方法。然而，TACE 后的生存率可能差异很大，这表明需要更准确地选择患者，以提高治疗效果。我们已经探讨了血液中性粒细胞与淋巴细胞比值（NLR）作为 TACE 后生存预测指标的预后能力，NLR 是全身炎症的生物标志物。我们选择了 54 名符合 TACE 条件的 HCC 患者。收集了临床病理变量，包括人口统计学、肿瘤分期、肝功能储备和实验室变量。使用单因素和多因素 Cox 回归模型研究了 TACE 前后 NLR 的动态变化作为生存预测指标的能力。与 NLR 持续异常的患者相比，TACE 后 NLR 保持稳定或正常化的患者总生存率显著提高，达到 26 个月（P = 0.006）。单因素分析中，其他生存预测指标包括：意大利肝癌计划评分（Cancer of the Liver Italian Program score，CLIP score）（P = 0.05）、肝内播散（P = 0.01）、肿瘤直径> 5 cm（P = 0.02）、> 1 次 TACE（P = 0.01）、甲胎蛋白（alpha-fetoprotein，AFP）≥ 400 ng/ml（P = 0.002）和 TACE 后的影像学反应（P < 0.001）。TACE 后 NLR 改善（P = 0.03）和 TACE 后影像学反应（P = 0.003）在多因素分析中仍然是独立的生存预测指标。治疗后 AFP 的变化不能预测生存。NLR 持续升高的患者 TACE 后结局较差。NLR 是一种简单且普遍可用的分层生物标志物，可以帮助识别 TACE 后具有显著生存优势的患者。
