Pre-treatment neutrophil-to-lymphocyte ratio affects survival in patients with advanced hepatocellular carcinoma treated with sorafenib

Abstract

Sorafenib is the first systemic therapy to demonstrate survival benefit in advanced hepatocellular carcinoma (HCC) in randomized controlled trials with rigorous patient selection. Neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor survival in various solid tumors. Our aim is to evaluate the prognostic role of NLR in HCC patients treated with sorafenib. A total of 105 advanced HCC patients treated with sorafenib were retrospectively reviewed, and relevant data from the clinical records were collected. Univariate and multivariate analysis were carried out to identify factors associated with survival. The median age of the cohort was 59.7 years, and 84.8 % were Child-Pugh class A, and 86.7 % had ECOG performance status 0 or 1. Median duration of sorafenib treatment was 100 days. Median overall survival (OS) of the entire cohort was 8.03 months. Median OS was 5.23 months (95 % CI 2.96-7.50 months) and 10.05 months (95 % IC 2.52-18.47 months) for patients with NLR > 3.5 and NLR ≤ 3.5, respectively (p = 0.002). Alpha-fetoprotein >1,030 ng/mL and serum albumin ≤3.8 g/dL were also associated with worse prognosis (p = 0.006 and p = 0.042, respectively). The subgroup of patients with high alpha-fetoprotein, low albumin and NLR > 3.5 had median OS of 1.7 months, whereas the subgroup with none of these parameters had median OS of 16.5 months (p < 0.001). NLR affects survival in advanced HCC patients treated with sorafenib. Selecting HCC patients based on the laboratorial features may improve the therapeutic effectiveness of sorafenib.

Neutrophil to lymphocyte ratio as an indicator of the malignant behaviour of hepatocellular carcinoma

“…The NLR has been found to be a prognostic risk factor for HCC after treatments other than surgery including transplantation, such as TACE, ablation therapy and sorafenib. These results suggest that the NLR reflects the malignant potential of HCC.…”

Prognostic value of the neutrophil-to-lymphocyte ratio in the ARQ 197-215 second-line study for advanced hepatocellular carcinoma

“…The only remarkable association was observed with respect to the PLR, which is another marker of systemic inflammatory response. Present data on the relationship between PLR and survival in advanced HCC are scarce and rather conflicting [13, 19], whereas overall data on NLR appear to be more robust. Recently, platelets counts, in addition to ANC and ALC, have been incorporated within a systemic immune-inflammation index (SII) that allowed to discriminate prognosis in a retrospective cohort of 56 HCC patients treated with sorafenib [14].…”

Pre-radiotherapy neutrophil-to-lymphocyte ratio as an independent prognostic factor in patients with locally advanced hepatocellular carcinoma treated with radiotherapy

“…The measurement of the NLR would be helpful in predicting the prognosis of malignant cancers such as gastric [12], lung [13], breast [8], pancreatic [11], and colorectal [9] cancers. In patients with HCC, a prognostic role of the NLR has been investigated after treatments including surgical resection [10, 17], transplantation [14], RFA [16], TACE [18–20], and sorafenib [15]. In addition, a recently reported meta-analysis demonstrated the role of the NLR [26].…”