Felismino Tiago, Martins Luanna, Barroso Matheus, Carvalho Daniela, Brito Angelo, Maccali Claudia, Coimbra Felipe
Department of Clinical Oncology, A.C. Camargo Cancer Center, São Paulo, Brazil.
Department of Hepatology, A.C. Camargo Cancer Center, São Paulo, Brazil.
J Gastrointest Cancer. 2025 Aug 19;56(1):175. doi: 10.1007/s12029-025-01299-5.
Hepatocellular carcinoma (HCC) is a globally prevalent malignancy with high mortality and limited predictive biomarkers. The neutrophil-to-lymphocyte ratio (NLR), a systemic inflammation marker, has been proposed as a prognostic tool. This study aimed to evaluate the association between baseline NLR and clinical outcomes in patients with advanced HCC treated with first-line immunotherapy.
We conducted a retrospective analysis of 58 consecutive patients with advanced HCC treated with atezolizumab plus bevacizumab or durvalumab plus tremelimumab at a Latin American cancer center between July 2020 and March 2025. Baseline NLR was calculated from pretreatment blood counts and dichotomized using a cut-off of 4. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Univariable and multivariable Cox regression models were applied to assess prognostic and predictive factors. The association between NLR and disease control rate (DCR) was evaluated using logistic regression.
Among 58 patients, 15 (28.8%) had NLR ≥ 4. Median PFS was significantly shorter in patients with NLR ≥ 4 compared to those with NLR < 4 (2.3 vs. 8.2 months; p < 0.001). In multivariable analysis, NLR ≥ 4 remained independently associated with inferior PFS (HR 3.90; 95% CI, 1.83-8.33; p < 0.001). NLR was not associated with OS. Patients with NLR ≥ 4 had markedly lower odds of achieving disease control (OR 0.04; 95% CI, 0.002-0.28; p = 0.005).
Baseline NLR ≥ 4 is associated with inferior PFS and reduced DCR in patients with advanced HCC receiving immunotherapy. NLR may serve as a cost-effective predictive biomarker to inform immunotherapy strategy.
肝细胞癌（HCC）是一种全球普遍存在的恶性肿瘤，死亡率高且预测生物标志物有限。中性粒细胞与淋巴细胞比值（NLR）作为一种全身炎症标志物，已被提议作为一种预后工具。本研究旨在评估一线免疫治疗的晚期HCC患者基线NLR与临床结局之间的关联。
我们对2020年7月至2025年3月期间在拉丁美洲一家癌症中心接受阿替利珠单抗联合贝伐单抗或度伐利尤单抗联合曲美木单抗治疗的58例连续晚期HCC患者进行了回顾性分析。基线NLR根据治疗前血常规计算，并以4为界值进行二分法划分。采用Kaplan-Meier法估计无进展生存期（PFS）和总生存期（OS），并使用对数秩检验进行比较。应用单变量和多变量Cox回归模型评估预后和预测因素。使用逻辑回归评估NLR与疾病控制率（DCR）之间的关联。
58例患者中，15例（28.8%）NLR≥4。与NLR<4的患者相比，NLR≥4的患者中位PFS显著缩短（2.3个月对8.2个月；p<0.001）。在多变量分析中，NLR≥4仍然与较差的PFS独立相关（HR 3.90；95%CI，1.83-8.33；p<0.001）。NLR与OS无关。NLR≥4的患者实现疾病控制的几率明显较低（OR 0.04；95%CI，0.002-0.28；p=0.005）。
基线NLR≥4与接受免疫治疗的晚期HCC患者较差的PFS和降低的DCR相关。NLR可作为一种经济有效的预测生物标志物，为免疫治疗策略提供依据。
