Tada Toshifumi, Kumada Takashi, Hiraoka Atsushi, Michitaka Kojiro, Atsukawa Masanori, Hirooka Masashi, Tsuji Kunihiko, Ishikawa Toru, Takaguchi Koichi, Kariyama Kazuya, Itobayashi Ei, Tajiri Kazuto, Shimada Noritomo, Shibata Hiroshi, Ochi Hironori, Yasuda Satoshi, Toyoda Hidenori, Fukunishi Shinya, Ohama Hideko, Kawata Kazuhito, Nakamura Shinichiro, Nouso Kazuhiro, Tsutsui Akemi, Nagano Takuya, Itokawa Norio, Hayama Korenobu, Arai Taeang, Imai Michitaka, Joko Kouji, Koizumi Yohei, Hiasa Yoichi
Department of Internal medicine, Himeji Red Cross Hospital, Himeji, Japan.
Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Japan.
Liver Int. 2020 Apr;40(4):968-976. doi: 10.1111/liv.14405. Epub 2020 Mar 1.
Lenvatinib, a newly developed molecularly targeted agent, has become available for patients with unresectable hepatocellular carcinoma (HCC). Neutrophil-to-lymphocyte ratio (NLR) has been reported to be associated with poor outcomes in numerous malignancies. In this study, we investigated the impact of NLR on associating outcomes in patients with HCC treated with lenvatinib.
A total of 237 patients with HCC treated with lenvatinib were included. We performed univariate and multivariate analyses in this cohort. In addition, we clarified appropriate cut-off NLR levels for associating overall survival using hazard ratio (HR) spline curves.
Cumulative overall survival at 100, 200 and 300 days was 95.2%, 83.4% and 66.6% respectively. Multivariate analysis showed that NLR ≥ 4 (HR, 1.874; 95% confidence interval [CI], 1.097-3.119), α-foetoprotein ≥ 400 ng/mL (HR, 1.969; 95% CI, 1.188-3.265) and modified albumin-bilirubin grade 2b or 3 (HR, 2.123; 95% CI, 1.267-3.555) were independently associated with overall survival. Cumulative progression-free survival at 100, 200 and 300 days was 72.4%, 49.8% and 38.7% respectively. Multivariate analysis showed that NLR ≥ 4 (HR, 1.897; 95% CI, 1.268-2.837) and BCLC stage ≥ C (HR, 1.516; 95% CI, 1.028-2.236) were independently associated with progression-free survival. Disease control rate was significantly different between the patients with low NLR (<4) (85.5%) and high NLR (≥4) (67.3%) (P = .007). Spline curve analysis revealed that NLR of approximately 3.0-4.5 is an appropriate cut-off for associating overall survival.
NLR can be associated with outcomes in patients with HCC treated with lenvatinib.
乐伐替尼是一种新开发的分子靶向药物，已可供不可切除肝细胞癌（HCC）患者使用。据报道，中性粒细胞与淋巴细胞比值（NLR）与多种恶性肿瘤的不良预后相关。在本研究中，我们调查了NLR对接受乐伐替尼治疗的HCC患者预后的影响。
共纳入237例接受乐伐替尼治疗的HCC患者。我们对该队列进行了单因素和多因素分析。此外，我们使用风险比（HR）样条曲线明确了与总生存相关的合适的NLR临界值水平。
100、200和300天时的累积总生存率分别为95.2%、83.4%和66.6%。多因素分析显示，NLR≥4（HR，1.874；95%置信区间[CI]，1.097 - 3.119）、甲胎蛋白≥400 ng/mL（HR，1.969；95% CI，1.188 - 3.265）和改良白蛋白 - 胆红素分级2b或3（HR，2.123；95% CI，1.267 - 3.555）与总生存独立相关。100、200和300天时的累积无进展生存率分别为72.4%、49.8%和38.7%。多因素分析显示，NLR≥4（HR，1.897；95% CI，1.268 - 2.837）和BCLC分期≥C（HR，1.516；95% CI，1.028 - 2.236）与无进展生存独立相关。低NLR（<4）患者（85.5%）和高NLR（≥4）患者（67.3%）的疾病控制率有显著差异（P = 0.007）。样条曲线分析显示，NLR约为3.0 - 4.5是与总生存相关的合适临界值。
NLR可能与接受乐伐替尼治疗的HCC患者的预后相关。
