Chon Young Eun, Park Hana, Hyun Hye Kyung, Ha Yeonjung, Kim Mi Na, Kim Beom Kyung, Lee Joo Ho, Kim Seung Up, Kim Do Young, Ahn Sang Hoon, Hwang Seong Gyu, Han Kwang-Hyub, Rim Kyu Sung, Park Jun Yong
Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea.
CHA Bundang Liver Center, CHA Bundang Hospital, Seongnam 13496, Korea.
Cancers (Basel). 2019 Apr 10;11(4):509. doi: 10.3390/cancers11040509.
The neutrophil-to-lymphocyte ratio (NLR) has recently been reported to predict the prognosis of hepatocellular carcinoma (HCC). We explored whether NLR predicted the survival of patients with HCC undergoing transarterial chemoembolization (TACE), and developed a predictive model. In total, 1697 patients with HCC undergoing TACE as first-line therapy at two university hospitals were enrolled (derivation set n = 921, internal validation set n = 395, external validation set n = 381). The tumor size, tumor number, AFP level, vascular invasion, Child-Pugh score, objective response after TACE, and NLR, selected as predictors of overall survival (OS) via multivariate Cox's regression model, were incorporated into a 14-point risk prediction model (SNAVCORN score). The time-dependent areas under the receiver-operating characteristic curves for OS at 1, 3, and 5 years predicted by the SNAVCORN score were 0.812, 0.734, and 0.700 in the derivation set. Patients were stratified into three risk groups by SNAVCORN score (low, 0-4; intermediate, 5-9; high, 10-14). Compared with the low-risk group, the intermediate-risk (HR 3.10, < 0.001) and high-risk (HR 7.37, < 0.001) groups exhibited significantly greater mortality. The prognostic performance of the SNAVCORN score including NLR in patients with HCC treated with TACE was remarkable, much better than those of the conventional scores. The SNAVCORN score will guide future HCC treatment decisions.
最近有报道称中性粒细胞与淋巴细胞比值（NLR）可预测肝细胞癌（HCC）的预后。我们探讨了NLR是否能预测接受经动脉化疗栓塞术（TACE）的HCC患者的生存情况，并建立了一个预测模型。共有1697例在两家大学医院接受TACE作为一线治疗的HCC患者入组（推导集n = 921，内部验证集n = 395，外部验证集n = 381）。通过多变量Cox回归模型选择肿瘤大小、肿瘤数量、甲胎蛋白水平、血管侵犯、Child-Pugh评分、TACE后的客观反应以及NLR作为总生存期（OS）的预测指标，并将其纳入一个14分的风险预测模型（SNAVCORN评分）。在推导集中，SNAVCORN评分预测的1年、3年和5年OS的受试者工作特征曲线下的时间依赖性面积分别为0.812、0.734和0.700。根据SNAVCORN评分将患者分为三个风险组（低风险，0 - 4分；中风险，5 - 9分；高风险，10 - 14分）。与低风险组相比，中风险组（HR 3.10，< 0.001）和高风险组（HR 7.37，< 0.001）的死亡率显著更高。在接受TACE治疗的HCC患者中，包含NLR的SNAVCORN评分的预后性能显著，远优于传统评分。SNAVCORN评分将指导未来HCC的治疗决策。
