Ochi Hironori, Kurosaki Masayuki, Joko Kouji, Mashiba Toshie, Tamaki Nobuharu, Tsuchiya Kaoru, Marusawa Hiroyuki, Tada Toshifumi, Nakamura Shinichiro, Narita Ryoichi, Uchida Yasushi, Akahane Takehiro, Kondo Masahiko, Mori Nami, Takaki Shintaro, Tsuji Keiji, Kusakabe Atsunori, Furuta Koichiro, Kobashi Haruhiko, Arai Hirotaka, Nonogi Michiko, Tamada Takashi, Hasebe Chitomi, Izumi Namiki
Center for Liver-Biliary-Pancreatic Disease, Matsuyama Red Cross Hospital, Matsuyama, Japan.
Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan.
Hepatol Res. 2023 Jan;53(1):61-71. doi: 10.1111/hepr.13836. Epub 2022 Oct 4.
We investigated pretreatment neutrophil-to-lymphocyte ratio (NLR) for predicting survival outcomes of atezolizumab plus bevacizumab therapy for hepatocellular carcinoma (HCC) and determined the predictive ability of combined liver reserve-NLR.
This retrospective, multicenter study enrolled 242 patients receiving atezolizumab plus bevacizumab for unresectable HCC. Pretreatment NLR <2.56 was designated as the "low group" and NLR ≥2.56 as the "high group" (120 and 122 patients, respectively). Propensity score-matched analysis was undertaken between the low and high groups.
In this cohort, the objective response and disease control rates were 20% and 72.5%, respectively, in the low group and 19.6% and 72.9%, respectively, in the high group. After matching, median progression-free survival (PFS) time was 283 and 167 days in the low and high groups, respectively (p = 0.022). Neutrophil-to-lymphocyte ratio ≥2.56 (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.05-2.28; p = 0.028), modified albumin-bilirubin index (mALBI) grade 2b or 3 (HR 1.55; 95% CI, 1.05-2.29; p = 0.025), and protein induced by vitamin K absence or antagonist-II ≥ 400 (HR 2.03; 95% CI, 1.36-3.02; p = 0.001) were significantly associated with PFS in univariate analysis using the Cox proportional hazards model. In cases involving mALBI grade 1 or 2a (n = 131), the median PFS time was not reached in the low group, whereas it was 210 days in the high group (p = 0.037).
Pretreatment NLR is a simple tool for routine measurement in clinical practice. It can predict PFS in patients with unresectable HCC treated with atezolizumab plus bevacizumab, especially mALBI grade 1 or 2a.
我们研究了治疗前中性粒细胞与淋巴细胞比值（NLR）对预测阿替利珠单抗联合贝伐单抗治疗肝细胞癌（HCC）生存结局的作用，并确定了联合肝脏储备功能-NLR的预测能力。
这项回顾性多中心研究纳入了242例接受阿替利珠单抗联合贝伐单抗治疗不可切除HCC的患者。将治疗前NLR<2.56定义为“低分组”，NLR≥2.56定义为“高分组”（分别为120例和122例患者）。对低分组和高分组进行倾向评分匹配分析。
在该队列中，低分组的客观缓解率和疾病控制率分别为20%和72.5%，高分组分别为19.6%和72.9%。匹配后，低分组和高分组的中位无进展生存期（PFS）分别为283天和167天（p = 0.022）。在使用Cox比例风险模型的单因素分析中，中性粒细胞与淋巴细胞比值≥2.56（风险比[HR]，1.54；95%置信区间[CI]，1.05 - 2.28；p = 0.028）、改良白蛋白-胆红素指数（mALBI）2b或3级（HR 1.55；95% CI，1.05 - 2.29；p = 0.025）以及维生素K缺乏或拮抗剂-II诱导蛋白≥400（HR 2.03；95% CI，1.36 - 3.02；p = 0.001）与PFS显著相关。在mALBI 1级或2a级（n = 131）的病例中，低分组的中位PFS时间未达到，而高分组为210天（p = 0.037）。
治疗前NLR是临床实践中常规测量的一种简单工具。它可以预测接受阿替利珠单抗联合贝伐单抗治疗的不可切除HCC患者的PFS，尤其是mALBI 1级或2a级患者。
