Interventional Radiology Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
Mayo Clinic, Jacksonville, FL, USA.
Eur J Nucl Med Mol Imaging. 2021 Jul;48(8):2624-2634. doi: 10.1007/s00259-020-05186-y. Epub 2021 Jan 13.
To study the prognostic significance of neutrophil and lymphocyte dynamics in patients with hepatocellular carcinoma (HCC) treated with radioembolization.
A retrospective, single-center review of clinical records and treatment parameters (liver volume treated, administered activity, and radiation dose) in consecutive patients who received radioembolization for HCC was performed between August 20, 2015, and May 24, 2019. Neutrophil and lymphocyte variables associated with overall survival (OS) were determined by Barcelona Clinic Liver Cancer (BCLC) stage and were correlated with radioembolization treatment parameters. Statistical methods included Wilcoxon signed-rank test, univariate, and multivariate Cox regression analysis; receiver operating characteristic analysis; and the Kaplan-Meier method.
One hundred sixty-three patients with a median 67.0 years of age were included for analysis. Eighty-one percent of patients received segmental radioembolization with a median treatment dose of 358 Gray (interquartile range 256-497). The post-treatment lymphocyte count decreased significantly in 94.5 % (p < 0.001) of patients but was not predictive of OS (p = 0.248). The pre-procedure neutrophil to lymphocyte ratio (NLR) was not predictive of OS (p = 0.891), and the 1-month post-procedure NLR was a borderline independent predictor of OS (p = 0.05). The NLR ratio (NLRR = NLR/NLR) (Hazard ratio [HR], 1.31; 95% Cl, 1.04-1.66) and change in NLR (ΔNLR= NLR - NLR) (HR, 1.09; 95% CI, 1.02-1.15) were associated with worse OS in BCLC C patients. NLRR (> 3.17) and ΔNLR (> 3.74) were independent predictors when adjusted for tumor presentation, treatment parameters, and liver function. Volume of liver treated and administered activity positively correlated with NLRR and ΔNLR (p < 0.001).
A decrease in lymphocyte count is common after radioembolization, but of little clinical impact. Neither pre-treatment or post-treatment NLR was a predictor of survival in our study population. NLRR and ΔNLR were independent predictors of survival in BCLC stage C disease and had positive correlations with volume of liver tissue treated and administered activity.
研究中性粒细胞和淋巴细胞动态变化对接受放射性栓塞治疗的肝细胞癌（HCC）患者的预后意义。
对 2015 年 8 月 20 日至 2019 年 5 月 24 日期间接受放射性栓塞治疗 HCC 的连续患者的临床记录和治疗参数（治疗的肝体积、给予的活性和辐射剂量）进行回顾性、单中心回顾分析。通过巴塞罗那临床肝癌（BCLC）分期确定与总生存期（OS）相关的中性粒细胞和淋巴细胞变量，并与放射性栓塞治疗参数相关联。统计方法包括 Wilcoxon 符号秩检验、单变量和多变量 Cox 回归分析、受试者工作特征分析和 Kaplan-Meier 方法。
纳入了 163 名中位年龄为 67.0 岁的患者进行分析。81%的患者接受了节段性放射性栓塞治疗，中位治疗剂量为 358 格雷（四分位距 256-497）。94.5%（p < 0.001）的患者在治疗后淋巴细胞计数显著下降，但与 OS 无关（p = 0.248）。治疗前中性粒细胞与淋巴细胞比值（NLR）对 OS 无预测意义（p = 0.891），而治疗后 1 个月 NLR 是 OS 的边缘独立预测因素（p = 0.05）。NLR 比值（NLRR = NLR/NLR）（危险比[HR]，1.31；95%可信区间，1.04-1.66）和 NLR 变化（ΔNLR = NLR - NLR）（HR，1.09；95%CI，1.02-1.15）与 BCLC C 期患者的 OS 较差相关。NLRR（>3.17）和ΔNLR（>3.74）在调整肿瘤表现、治疗参数和肝功能后是独立的预测因素。治疗的肝体积和给予的活性与 NLRR 和ΔNLR 呈正相关（p < 0.001）。
放射性栓塞后淋巴细胞计数普遍下降，但对临床影响不大。在本研究人群中，治疗前或治疗后 NLR 均不是生存的预测因子。NLRR 和ΔNLR 是 BCLC 期 C 疾病的独立生存预测因子，与治疗的肝组织体积和给予的活性呈正相关。
