Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, 5959 Harry Hines Blvd, POB 1, Suite 420, Dallas, TX, 75390-8887, USA.
Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA.
Dig Dis Sci. 2022 Jun;67(6):2666-2676. doi: 10.1007/s10620-021-07001-6. Epub 2021 May 3.
The neutrophil-lymphocyte ratio (NLR) has been proposed as a prognostic biomarker for cirrhosis and non-liver malignancies. We aimed to evaluate the prognostic value of NLR in a diverse cohort of patients with hepatocellular carcinoma (HCC).
We performed a retrospective study of patients diagnosed with HCC between 2008 and 2017 at two large US health systems. We used Cox proportional hazard and multivariable ordinal logistic regression models to identify factors associated with overall survival and response to first HCC treatment, respectively. Primary variables of interest were baseline NLR and delta NLR, defined as the difference between pre- and post-treatment NLR.
Among 1019 HCC patients, baseline NLR was < 5 in 815 (80.0%) and ≥ 5 in 204 (20.0%). Patients with NLR ≥ 5 had a higher proportion of infiltrative tumors (36.2% vs 22.3%), macrovascular invasion (39.6% vs 25.5%), metastatic disease (20.6% vs 11.4%), and AFP > 200 ng/mL (45.6% vs 33.8%). Baseline NLR ≥ 5 was independently associated with higher mortality (median survival 4.3 vs 15.1 months; adjusted HR 1.70, 95%CI 1.41-2.06), with differences in survival consistent across BCLC stages. After adjusting for baseline covariates including NLR, delta NLR > 0.26 was also independently associated with increased mortality (HR 1.42, 95%CI 1.14-1.78). In a secondary analysis, high NLR was associated with lower odds of response to HCC treatment (20.2% vs 31.6%; adjusted OR 0.55, 95%CI 0.32-0.95).
In a large Western cohort of patients with HCC, high baseline NLR and delta NLR were independent predictors of mortality.
NLR is an inexpensive test that may be a useful component of future HCC prognostic models.
中性粒细胞与淋巴细胞比值（NLR）已被提出作为肝硬化和非肝脏恶性肿瘤的预后生物标志物。我们旨在评估 NLR 在不同人群的肝细胞癌（HCC）患者中的预后价值。
我们对 2008 年至 2017 年间在美国两个大型医疗系统诊断为 HCC 的患者进行了回顾性研究。我们使用 Cox 比例风险和多变量有序逻辑回归模型，分别确定与总生存期和首次 HCC 治疗反应相关的因素。主要感兴趣的变量是基线 NLR 和 delta NLR，定义为治疗前后 NLR 的差异。
在 1019 例 HCC 患者中，815 例（80.0%）的基线 NLR<5，204 例（20.0%）的 NLR≥5。NLR≥5 的患者浸润性肿瘤比例更高（36.2%比 22.3%），大血管侵犯比例更高（39.6%比 25.5%），转移性疾病比例更高（20.6%比 11.4%），甲胎蛋白（AFP）>200ng/mL 比例更高（45.6%比 33.8%）。基线 NLR≥5 与更高的死亡率独立相关（中位生存期 4.3 与 15.1 个月；调整后的 HR 1.70，95%CI 1.41-2.06），且在 BCLC 各期之间的生存差异一致。在校正包括 NLR 在内的基线协变量后，delta NLR>0.26 也与死亡率升高独立相关（HR 1.42，95%CI 1.14-1.78）。在二次分析中，高 NLR 与 HCC 治疗反应较低的几率相关（20.2%比 31.6%；调整后的 OR 0.55，95%CI 0.32-0.95）。
在西方的 HCC 患者大队列中，基线 NLR 和 delta NLR 较高是死亡率的独立预测因素。
NLR 是一种廉价的检测方法，可能是未来 HCC 预后模型的有用组成部分。
