Chen Jia-Li, Guo Lu, Wu Zhen-Ying, He Kun, Li Han, Yang Chi, Han Yun-Wei
Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China.
Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China.
World J Gastrointest Oncol. 2024 Feb 15;16(2):372-385. doi: 10.4251/wjgo.v16.i2.372.
Circulating tumor cell (CTC) count and neutrophil-to-lymphocyte ratio (NLR) are both closely associated with the prognosis of hepatocellular carcinoma (HCC).
To investigate the prognostic value of combining these two indicators in HCC.
Clinical data were collected from patients with advanced HCC who received immune therapy combined with targeted therapy at the Department of Oncology, the Affiliated Hospital of Southwest Medical University, Sichuan, China, from 2021 to 2023. The optimal cutoff values for CTC programmed death-ligand 1 (PD-L1) (+) > 1 or CTC PD-L1 (+) ≤ 1 and NLR > 3.89 or NLR ≤ 3.89 were evaluated using X-Tile software. Patients were categorized into three groups based on CTC PD-L1 (+) counts and NLR: CTC-NLR (0), CTC-NLR (1), and CTC-NLR (2). The relationship between CTC-NLR and clinical variables as well as survival rates was assessed.
Patients with high CTC PD-L1 (+) expression or NLR at baseline had shorter median progression-free survival (mPFS) and median overall survival (mOS) than those with low levels of CTC PD-L1 (+) or NLR ( < 0.001). Meanwhile, patients in the CTC-NLR (2) group showed a significant decrease in mPFS and mOS. Cox regression analysis revealed that alpha-fetoprotein (AFP), CTC PD-L1 (+), and CTC-NLR were independent predictors of OS. The time-dependent receiver operating characteristic curve showed that the area under the curve of CTC-NLR at 12 months (0.821) and 18 months (0.821) was superior to that of AFP and CTC PD-L1 (+).
HCC patients with high CTC PD-L1 (+) or NLR expression tend to exhibit poor prognosis, and a high baseline CTC-NLR score may indicate low survival. CTC-NLR may serve as an effective prognostic indicator for patients with advanced HCC receiving immunotherapy combined with targeted therapy.
循环肿瘤细胞（CTC）计数和中性粒细胞与淋巴细胞比值（NLR）均与肝细胞癌（HCC）的预后密切相关。
探讨联合这两个指标对HCC的预后价值。
收集2021年至2023年在中国四川省西南医科大学附属医院肿瘤科接受免疫治疗联合靶向治疗的晚期HCC患者的临床资料。使用X-Tile软件评估CTC程序性死亡配体1（PD-L1）（+）>1或CTC PD-L1（+）≤1以及NLR>3.89或NLR≤3.89的最佳临界值。根据CTC PD-L1（+）计数和NLR将患者分为三组：CTC-NLR（0）、CTC-NLR（1）和CTC-NLR（2）。评估CTC-NLR与临床变量以及生存率之间的关系。
基线时CTC PD-L1（+）表达或NLR高的患者中位无进展生存期（mPFS）和中位总生存期（mOS）比CTC PD-L1（+）或NLR水平低的患者短（<0.001）。同时，CTC-NLR（2）组患者的mPFS和mOS显著降低。Cox回归分析显示，甲胎蛋白（AFP）、CTC PD-L1（+）和CTC-NLR是总生存期的独立预测因素。时间依赖性受试者工作特征曲线显示，12个月（0.821）和18个月（0.821）时CTC-NLR的曲线下面积优于AFP和CTC PD-L1（+）。
CTC PD-L1（+）或NLR表达高的HCC患者往往预后较差，高基线CTC-NLR评分可能表明生存率低。CTC-NLR可能作为接受免疫治疗联合靶向治疗的晚期HCC患者的有效预后指标。
