Wang Shuai, Geng Hefeng, Li Yizhen, Xu Ziang, Yang Kaisi, Yang Ling, Hui Fuhai, Zhang Yingshi
Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, 110016 China.
Bei Fang Hospital of Shenyang Pharmaceutical University, No. 103, Wenhua Road, Shenhe District, Shenyang, 110016 China.
Heliyon. 2024 May 4;10(9):e30759. doi: 10.1016/j.heliyon.2024.e30759. eCollection 2024 May 15.
Transarterial chemoembolization (TACE) is a common treatment for hepatocellular carcinoma (HCC), but the best therapeutic agent for TACE treatment has not been determined. The neutrophil/lymphocyte ratio (NLR) is a systemic immune system marker; however, the ability of the NLR to predict the prognosis of patients with HCC is unknown, and no studies have been conducted to determine the most appropriate TACE regimen for HCC patients with different NLRs.
The PubMed, Embase, Web of Science, and CNKI databases were searched through May 28, 2023. Comparisons of overall survival (OS) among cohort studies with different NLRs and different TACE treatment regimens were performed with a random effects model.
Thirty-five studies involving 9210 patients were included in this meta-analysis. The results showed that Group 3-4 (NLR<2.5) patients had a significantly longer OS than Group 1-2 (NLR 2.5-5.0). Among the patients, Group 1-3 (NLR 2.0-5.0) patients had the best survival after treatment with adriamycin (lnHR (95 % CI = 0.48 [0.31, 0.75] and lnHR (95 % CI = 0.41 [0.19, 0.91]). Among the Group 4 patients (NLR<2.0), the best outcome was obtained with platinum + adriamycin (lnHR (95 % CI = 0.59 [0.45, 0.78]), followed by adriamycin. A subgroup analysis of TACE combined with other treatments showed that adriamycin combined with sorafenib was the most effective and superior to the other treatment agents.
The NLR can be used to predict the prognosis of HCC patients treated with TACE; the higher the NLR is, the worse the prognosis. Adriamycin may be the best therapeutic agent for HCC patients treated with TACE.
经动脉化疗栓塞术（TACE）是肝细胞癌（HCC）的一种常见治疗方法，但TACE治疗的最佳治疗药物尚未确定。中性粒细胞/淋巴细胞比值（NLR）是一种全身免疫系统标志物；然而，NLR预测HCC患者预后的能力尚不清楚，且尚未开展研究来确定针对不同NLR的HCC患者最合适的TACE方案。
检索截至2023年5月28日的PubMed、Embase、Web of Science和中国知网数据库。采用随机效应模型对不同NLR和不同TACE治疗方案的队列研究中的总生存期（OS）进行比较。
本荟萃分析纳入了35项涉及9210例患者的研究。结果显示，第3 - 4组（NLR<2.5）患者的OS明显长于第1 - 2组（NLR 2.5 - 5.0）。在这些患者中，第1 - 3组（NLR 2.0 - 5.0）患者在接受阿霉素治疗后生存期最佳（lnHR（95%CI = 0.48 [0.31, 0.75]）和lnHR（95%CI = 0.41 [0.19, 0.91]）。在第4组患者（NLR<2.0）中，铂类 + 阿霉素治疗效果最佳（lnHR（95%CI = 0.59 [0.45, 0.78]），其次是阿霉素。TACE联合其他治疗的亚组分析显示，阿霉素联合索拉非尼最有效，优于其他治疗药物。
NLR可用于预测接受TACE治疗的HCC患者的预后；NLR越高，预后越差。阿霉素可能是接受TACE治疗的HCC患者的最佳治疗药物。
