Neutrophil/lymphocyte ratio as a prognostic indicator of hepatic arterial infusion chemotherapy with arterial cisplatin plus continuous 5‐fluorouracil

Tajiri, Kazuto; Kawai, Kengo; Minemura, Masami; Yasumura, Satoshi; Hosokawa, Ayumu; Kawabe, Hideto; Tomizawa, Gakuto; Sugiyama, Toshiro

doi:10.1111/hepr.12417

Cited by 24 publications

(27 citation statements)

References 42 publications

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“…Inflammation-related markers, such as the absolute leukocyte count, C-reactive protein level, neutrophil to lymphocyte ratio (NLR), and cytokine level, have been linked to clinical outcomes in patients with various malignancies, including HCC [34]. In a study by Tajiri et al [35], NLRs of 4 or more (odds ratio, 0.49; p=0.04) correlated with low RRs, whereas NLRs less than 4 correlated with prolonged OS, as did treatment response. In a study by Terashima et al [36], patients with high NLRs (cut-off value=2.87) had significantly shorter MSTs (5.6 and 20.7 months, respectively; p<0.01) and significantly worse RRs (21.1% and 37.7%, respectively; p<0.01) than patients with low NLRs.…”

Section: Predictive Factors For Response and Survivalmentioning

confidence: 99%

Current Status of Hepatic Arterial Infusion Chemotherapy

Obi

Sato

Kawai³

2015

Liver Cancer

106

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Background: Hepatic arterial infusion chemotherapy (HAIC) is frequently used to treat advanced hepatocellular carcinoma (HCC) in Asian countries. However, there is a lack of evidence supporting the use of HAIC. Summary: Many studies report high response rates in patients with advanced HCC receiving HAIC, and clinical responses translate to survival benefits. Therefore, prediction of an antitumor response is important in selecting appropriate treatments. There are no proven post-sorafenib therapeutic measures or procedures for HCC patients with poor liver function, and HAIC is one of the few options for patients in these situations. Despite studies showing its effectiveness, the use of HAIC for treatment of advanced HCC is unclear because convincing data from large-scale randomized clinical trials are lacking. For HAIC to become a standard treatment for HCC, such trials must establish its efficacy compared with other HCC therapies; prediction of antitumor response in HAIC may aid trial design, and a multi-center, open-labelled, randomized clinical trial of HAIC in advanced HCC is currently in progress. Optimization of HCC treatment protocols and regimens is also required. Key message: We think that both HAIC and sorafenib are effective treatments for advanced HCC, and this review presents evidence supporting this contention.

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Section: Predictive Factors For Response and Survivalmentioning

confidence: 99%

Current Status of Hepatic Arterial Infusion Chemotherapy

Obi

Sato

Kawai³

2015

Liver Cancer

106

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“…The Glasgow Prognostic Score (GPS), which combines serum CRP with albuminemia and has been demonstrated to be a predictive factor in various cancers, is regarded as a prognostic milestone among all the systems (Forrest, McMillan, & McArdle, ; McMillan, ). Other prognostic systems such as neutrophil to lymphocyte ratio (NLR) (Cho et al, ; McNamara et al, ; Tajiri et al, ), platelet to lymphocyte ratio (PLR) (Kwon, Kim, & Oh, ; Li et al, ), and fibrinogen (He et al, ; Luo, Kim, Kim, Lee, & Song, ; Seebacher et al, ), can help predict the progression, metastasis, and prognosis of cancer patients.…”

Section: Introductionmentioning

confidence: 99%

The combination of plasma fibrinogen and neutrophil lymphocyte ratio (F‐NLR) is a predictive factor in patients with resectable non small cell lung cancer

Wang

Zhao

Zhang

et al. 2017

Journal Cellular Physiology

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The prognostic value of inflammation indexes in non small cell lung cancer (NSCLC) was not established. Therefore, we assessed the clinical applicability of the F-NLR score, which is based on fibrinogen (F) and the neutrophil-lymphocyte ratio (NLR), and the glasgow prognostic score (GPS) to predict the prognoses of NSCLC patients. We retrospectively identified 515 patients with stage I/II/IIIA who underwent surgery at our institution, and evaluated their preoperative serum levels of CRP, albumin, fibrinogen, neutrophil count, and the lymphocyte count. The cut-off values of the fibrinogen level and NLR were determined with receiver operating characteristic (ROC) curve. GPS was classified into three groups as previously described. The disease free survival (DFS) and overall survival (OS) were calculated by the Kaplan-Meier method. Categorical variables were compared using the χ test. Survival curves were estimated using the Kaplan-Meier method, and the Cox proportional hazard model was used to assess the prognostic factors. The F-NLR was significantly associated with sex (p = 0.000), smoking history (p = 0.014), lesion type (p = 0.000), histologic type (p = 0.000), T stage (p = 0.000), venous invasion (p = 0.000), lymphatic invasion (p = 0.000), and TNM stage (p = 0.000). The 5-year DFS rates in F-NLR groups 0, 1, and 2 were 46.7%, 36.4%, 30.1%, respectively (p = 0.000), and the 5-year overall survival (OS) rates in the above three groups were 52.0%, 39.8%, 32.1%, respectively (p = 0.000). Multivariate analysis showed that venous invasion (p = 0.036), lymph node metastasis (p = 0.000), and F-NLR (p = 0.034) were independent prognostic factors for DFS. Age (p = 0.015), venous invasion (p = 0.024), lymph node metastasis (p = 0.000), and F-NLR (p = 0.019) were independent prognostic factors for OS. Thus, F-NLR was the independent prognostic factor for both the DFS and OS. And patients with a high-risk preoperative F-NLR group may benefit from adjuvant therapy by subgroup analysis. Our results demonstrated that F-NLR, a novel inflammation-based grading system, as well as the GPS, appeared to have value as a promising clinical predictor of the prognosis for the resectable non small cell lung cancer patients.

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“…Terashima et al found that in 266 patients undergoing hepatic arterial infusion chemotherapy, elevated NLR was associated with a significantly worse response rate (55). Similar findings were revealed by Tajiri et al in 26 patients in which patients with elevated NLR were half as likely to respond to hepatic arterial infusion chemotherapy (56). Finally, elevated NLR in patients receiving selective internal radiation therapy (57) and those who underwent resection for tumors at least 10 cm in size (58) had significantly worse outcomes if NLR was elevated.…”

Section: Neutrophil Lymphocyte Ratio (Nlr)mentioning

confidence: 60%

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Rosenblatt

Tafesh

Halazun

2017

Transl. Gastroenterol. Hepatol.

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Since the advent of the Milan criteria in 1996 and its widespread adoption for selection of patients with hepatocellular carcinoma (HCC) who would benefit from transplant, there has been an extensive hunt for the ideal clinical biomarker to predict HCC recurrence. This is because Milan lack does not include tumor biology indices and recurrence rates remain in the 15-20% range worldwide. While a 'silver-bullet' biomarker has not been found, several useful inflammatory markers have been identified and used in scoring systems that supersede Milan in their ability to predict HCC recurrence post liver transplantation (LT). In this review, we aim to summarize the role of inflammatory markers paly in the selection of HCC patients awaiting LT. measured characteristic to indicate a biological process or response (19). They have the potential to assess the risk of recurrence in HCC without invasive testing, offering yet another tool in a physician's armamentarium to identify the patients who would benefit from LT and those who would not. Currently, several biomarkers are utilized in clinical practice, but both the AASLD and an international consensus (15,20) describe biomarkers as an area of future study. Alpha fetoprotein (AFP) (21)(22)(23)(24) and proteins induced by vitamin K absence II (PIVKA-II) (25-28) have been extensively studied and validated as predictors of HCC outcomes. However, there are patients who do not produce either biomarker and still have high risk of recurrence (29,30). Therefore, pursuing other biomarkers that assess the role of inflammation in malignancy is another method to identify patients at risk of recurrence. The link between inflammation and cancer was postulated in the year 1863 by Virchow, and inflammation has been linked with several gastrointestinal malignancies (31). In the last decade, there has been increasing interest in the use of inflammatory markers as tools to predict poor outcomes in patients with HCC. This review will focus of such inflammatory markers, the role they play in HCC, and how to potentially use these as selection tools for patients awaiting transplant. Neutrophil lymphocyte ratio (NLR)The NLR is a measure of the proportion of peripheral blood neutrophils to lymphocytes and has an important role in predicting outcomes in several malignancies. An elevated NLR can be a marker of both neutrophilia in response to inflammation or peripheral lymphopenia, both first demonstrated the use of NLR in predicting outcomes for HCC in 150 patients undergoing LT for HCC. Of the 13 patients with elevated NLR, 62% had recurrence and, as a cohort, had significantly worse OS and RFS. Of note, even patients within Milan criteria with an elevated NLR, compared to those with normal NLR, had a significantly worse survival (30% vs. 81%) (36). In the largest study in the MELD era from the United States examining post-LT outcomes for HCC, the MORAL score was evaluated for its ability to predict post-LT RFS. The MORAL score was constructed using Cox-regression analyses for factors imp...

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Neutrophil/lymphocyte ratio as a prognostic indicator of hepatic arterial infusion chemotherapy with arterial cisplatin plus continuous 5‐fluorouracil

Abstract: HAIC is a candidate for treatment of advanced HCC, and NLR may be a useful prognostic indicator for suitability of HAIC.

Cited by 24 publications

References 42 publications

Current Status of Hepatic Arterial Infusion Chemotherapy

Current Status of Hepatic Arterial Infusion Chemotherapy

The combination of plasma fibrinogen and neutrophil lymphocyte ratio (F‐NLR) is a predictive factor in patients with resectable non small cell lung cancer

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

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