Sukato Daniel C, Tohme Samer, Chalhoub Didier, Han Katrina, Zajko Albert, Amesur Nikhil, Orons Philip, Marsh James W, Geller David A, Tsung Allan
Departments of Surgery.
Epidemiology.
J Vasc Interv Radiol. 2015 Jun;26(6):816-24.e1. doi: 10.1016/j.jvir.2015.01.038. Epub 2015 Mar 29.
To assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with unresectable intermediate- or advanced-stage hepatocellular carcinoma (HCC) treated with yttrium-90 radioembolization (RE).
Retrospective chart review was performed for 176 patients with intermediate- or advanced-stage HCC treated with RE between August 2000 and November 2012. The appropriate NLR cutoff was determined by receiver operating characteristic curves. Demographic, clinical, radiographic, and pathologic parameters were compared between patients with a normal NLR (< 5) and those with an elevated NLR (≥ 5) before RE. Barcelona Clinic Liver Cancer (BCLC) stage-stratified univariate and multivariate analyses were conducted to determine variables associated with overall survival.
Under univariate analyses, patients with a normal NLR were found to have longer survival than individuals with a high NLR in intermediate/advanced-disease and advanced-disease cohorts. A multivariate Cox proportional-hazards model in the advanced-disease group confirmed that elevated NLR, high α-fetoprotein level, and low albumin level were independent predictors of worse survival.
This study provides stage-dependent evidence for the prognostic role of NLR in the radioembolized HCC cohort. Patients with BCLC stage C disease with elevated NLR may not derive benefit from RE, and other intervening modalities should be explored in this subpopulation.
评估中性粒细胞与淋巴细胞比值（NLR）在接受钇-90放射性栓塞（RE）治疗的不可切除的中晚期肝细胞癌（HCC）患者中的预后价值。
对2000年8月至2012年11月期间接受RE治疗的176例中晚期HCC患者进行回顾性病历审查。通过受试者工作特征曲线确定合适的NLR临界值。比较RE治疗前NLR正常（<5）和NLR升高（≥5）的患者的人口统计学、临床、影像学和病理参数。进行巴塞罗那临床肝癌（BCLC）分期分层的单因素和多因素分析，以确定与总生存相关的变量。
在单因素分析中，发现中晚期疾病和晚期疾病队列中NLR正常的患者比NLR高的患者生存时间更长。晚期疾病组的多因素Cox比例风险模型证实，NLR升高、甲胎蛋白水平高和白蛋白水平低是生存较差的独立预测因素。
本研究为NLR在放射性栓塞HCC队列中的预后作用提供了分期依赖性证据。NLR升高的BCLC C期疾病患者可能无法从RE中获益，应在该亚组中探索其他干预方式。
