Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Liver Int. 2021 Sep;41(9):2189-2199. doi: 10.1111/liv.14932. Epub 2021 May 24.
Programmed death 1 (PD-1) inhibitors have improved survival outcomes and produced durable responses in advanced hepatocellular carcinoma (HCC) for some patients. Here, we evaluated the relationship between the baseline and kinetics of the neutrophil-lymphocyte ratio (NLR) and clinical outcomes in nivolumab-treated HCC patients.
All consecutive HCC patients treated with nivolumab between July 2017 and June 2020 were screened for the eligibility. The NLRs were calculated before and at 2, 4 and 6 weeks after treatment. Survival outcomes were compared based on the baseline and kinetics of NLR. We additionally analysed the association of the baseline and dynamic changes in the NLR with hyperprogression (HPD).
Among the 194 included cases, most patients were male (82.0%) and had a Child-Pugh Class A disease (70.6%). Patients with a baseline NLR ≥ 3 (hazard ratio [HR] 2.46; 95% CI 1.63-3.71) had a poorer overall survival than patients with baseline NLR < 3. During the treatment, the NLR increased rapidly in patients developing HPD, and only a ΔNLR at 4 weeks was predictive of HPD. The risk of HPD increased by 20% for every 20% increase in the ΔNLR at 4 weeks. Accordingly, an NLR increase at 4 weeks (HR 1.79; 95% CI 1.19-2.68) was associated with an increased risk of death, especially among patients with a baseline NLR ≥ 3.
The baseline and on-treatment kinetics for the NLR are effective prognostic indicators in nivolumab-treated patients with HCC. This may help to guide patient selection and on-treatment strategies for immunotherapies in advanced HCC.
程序性死亡受体 1（PD-1）抑制剂改善了某些晚期肝细胞癌（HCC）患者的生存结局，并产生了持久的反应。在此，我们评估了基线和中性粒细胞与淋巴细胞比值（NLR）动力学与纳武利尤单抗治疗 HCC 患者临床结局之间的关系。
筛选了 2017 年 7 月至 2020 年 6 月期间接受纳武利尤单抗治疗的所有连续 HCC 患者，以评估其纳入资格。在治疗前和治疗后 2、4 和 6 周计算 NLR。根据 NLR 的基线和动力学比较生存结局。我们还分析了 NLR 的基线和动态变化与超进展（HPD）的相关性。
在纳入的 194 例患者中，大多数患者为男性（82.0%），且患有 Child-Pugh 分级 A 疾病（70.6%）。基线 NLR≥3（风险比[HR]2.46；95%可信区间 1.63-3.71）的患者总生存期较基线 NLR<3 的患者更差。在治疗过程中，发生 HPD 的患者的 NLR 迅速升高，仅 4 周时的 NLR 变化（ΔNLR）可预测 HPD。4 周时 NLR 每增加 20%，HPD 的风险增加 20%。相应地，4 周时 NLR 升高（HR 1.79；95%可信区间 1.19-2.68）与死亡风险增加相关，尤其是在基线 NLR≥3 的患者中。
基线和治疗期间 NLR 动力学是纳武利尤单抗治疗 HCC 患者的有效预后指标。这可能有助于指导晚期 HCC 患者的免疫治疗患者选择和治疗策略。
