炎症评分：北美队列中接受经动脉化疗栓塞的肝癌患者的比较与效用

Inflammatory Scores: Comparison and Utility in HCC Patients Undergoing Transarterial Chemoembolization in a North American Cohort.

作者信息

Young Shamar, Cam Isa, Gencturk Mehmet, Rubin Nathan, D'souza Donna, Flanagan Siobhan, Golzarian Jafar, Sanghvi Tina

机构信息

University of Minnesota, Department of Radiology, Division of Interventional Radiology, Minneapolis, MN, 55455, USA.

Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.

出版信息

J Hepatocell Carcinoma. 2021 Dec 1;8:1513-1524. doi: 10.2147/JHC.S335183. eCollection 2021.

DOI:10.2147/JHC.S335183

PMID:34881208

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8646226/

Abstract

BACKGROUND

The purpose of this study is to determine and compare the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate-aminotransferase-to-lymphocyte ratio (ALRI), systemic-inflammation index (SII) and lymphocyte count to predict oncologic outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).

MATERIALS AND METHODS

A single-center retrospective review of 296 patients who were treated for 457 HCCs was performed. Pre- and post-treatment laboratory and treatment outcome variables were collected. Objective radiologic response (ORR), progression-free survival (PFS), and overall survival (OS) were evaluated. Patients were categorized into above and below median scores and compared.

RESULTS

The median pretreatment NLR, PLR, ALRI, SII, and lymphocyte count were 2.7 (range: 0.4-55), 88.3 (range: 0.1-840), 71.8 (range: 0.1-910), 238.1 (range: 0.1-5150.8), and 1 (range: 0.1-5.2) 10/µL, respectively. Patients with above median ALRI scores were less likely to achieve an ORR as compared to those with below median ALRI values (132 (132/163, 81%) vs 150 (150/163, 92%), = 0.004). On univariate analysis, patients with above median pretreatment NLR (HR 1.41, 95% CI: 1.09-1.83, = 0.01) and below median lymphocyte count (HR 0.69, 95% CI: 0.53-0.92, = 0.01) had significantly worse PFS. The relationship between PFS and NLR ( = 0.08) as well as lymphocytes ( = 0.20) no longer remained on multivariate analysis. On univariate analysis, below median pretreatment NLR (HR 1.72, 95% CI: 1.2-2.45, = 0.003) and ALRI (HR 1.52, 95% CI: 1.05-2.2); = 0.03) as well as above median lymphocyte count (HR 0.48, 95% CI: 0.34-0.7, < 0.0001) were associated with improved OS. The significant relationship between lymphocytes and OS remained on multivariate analysis (HR 0.50, 95% CI: 0.28-0.9, = 0.02), but the relationship with NLR ( = 0.94) did not persist.

CONCLUSION

NLR is predictive of PFS and OS in patients with HCC undergoing TACE and may be superior to other inflammatory scores (PLR, ALRI, and SII) in this setting. However, lymphocyte count may be most predictive of OS.

摘要

背景

本研究的目的是确定并比较中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、天冬氨酸转氨酶与淋巴细胞比值（ALRI）、全身炎症指数（SII）及淋巴细胞计数预测接受经动脉化疗栓塞术（TACE）的肝细胞癌（HCC）患者肿瘤学结局的能力。

材料与方法

对296例接受457次HCC治疗的患者进行单中心回顾性研究。收集治疗前及治疗后的实验室检查和治疗结局变量。评估客观放射学反应（ORR）、无进展生存期（PFS）和总生存期（OS）。将患者分为高于和低于中位数评分两组并进行比较。

结果

治疗前NLR、PLR、ALRI、SII及淋巴细胞计数的中位数分别为2.7（范围：0.4 - 55）、88.3（范围：0.1 - 840）、71.8（范围：0.1 - 910）、238.1（范围：0.1 - 5150.8）及1（范围：0.1 - 5.2）×10⁹/μL。与ALRI值低于中位数的患者相比，ALRI评分高于中位数的患者达到ORR的可能性较小（132例（132/163，81%）对150例（150/163，92%），P = 0.004）。单因素分析显示，治疗前NLR高于中位数的患者（HR 1.41，95%CI：1.09 - 1.83，P = 0.01）及淋巴细胞计数低于中位数的患者（HR 0.69，95%CI：0.53 - 0.92，P = 0.01）的PFS显著更差。多因素分析中，PFS与NLR（P = 0.08）及淋巴细胞（P = 0.20）之间的关系不再显著。单因素分析显示，治疗前NLR低于中位数（HR 1.72，95%CI：1.2 - 2.45，P = 0.003）、ALRI低于中位数（HR 1.52，95%CI：1.05 - 2.2；P = 0.03）以及淋巴细胞计数高于中位数（HR 0.48，95%CI：0.34 - 0.7，P < 0.0001）与OS改善相关。淋巴细胞与OS之间的显著关系在多因素分析中仍然存在（HR 0.50，95%CI：0.28 - 0.9，P = 0.02），但与NLR的关系（P = 0.94）不再持续。