Dynamic Changes in Neutrophil-to-Lymphocyte Ratio are Associated with Survival and Liver Toxicity Following Stereotactic Body Radiotherapy for Hepatocellular Carcinoma

Hsiang, Chih-Weim; Huang, Wen‐Yen; Yang, Juxiang; Shen, Po-Chien; Dai, Yang-Hong; Wang, Ying-Fu; Lin, Chun–Shu; Chang, Wei‐Chou; Lo, Cheng‐Hsiang

doi:10.2147/jhc.s334933

Cited by 10 publications

(11 citation statements)

References 36 publications

(50 reference statements)

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“…Of note, markers correlating with overall survival might be specific to cancer histology, as we have previously reported for HCC versus CCA patients [47]. Three studies also reported inverse correlations between the baseline neutrophil-to-lymphocyte ratio (NLR) and treatment outcome (Byun et al: HR 1.03 (95%CI 1.01-1.06); p= 0.016) [48,50,53]. Hsiang and colleagues additionally reported an association between liver toxicity and the maximal change in NLR [liver toxicity rate (delta NLR< vs. >1.9): 7.5% vs. 35.1%].…”

Section: Circulating Blood Cellsmentioning

confidence: 68%

“…Potential Predictive Scores/Biomarkers ALBI [23][24][25][26][27]29] ALBI [23][24][25]29,39] Absolute lymphocyte count [43] Indocyanin Green Retention [35][36][37] Hepatocyte growth factor (HGF) [40,41] HGF [40,41] CD40 Ligand (CD40L) [45] sCD40L [40,45] Platelet-to-lymphocyte ratio [43] Transforming growth factor (TGF)-β [42] Neutrophile-to-Lymphocyte ratio [43,50,53] Neutrophile-to-Lymphocyte ratio [53] Interleukin 6 (IL-6) [43,44] Eotaxin [42] Interleukin 10 (IL-10) [44] TNF receptor I (TNFR-I) [46] Tumor Necrosis Factor receptor II [45] TNFR-II [45] Circulating lymphocyte counts [47,[49][50][51][52] Circulating lymphocyte counts [49] Tumor Necrosis Factor (TNF)-α [51] Micro RNAs [101] Cell-free DNA [90] Plasma metabolites [98] Ceramide [99] Programmed cell d...…”

Section: Potential Prognostic Scores/biomarkersmentioning

confidence: 99%

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Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers

Hauth

Roberts

Hong

et al. 2022

IJMS

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While the incidence of primary liver cancers has been increasing worldwide over the last few decades, the mortality has remained consistently high. Most patients present with underlying liver disease and have limited treatment options. In recent years, radiotherapy has emerged as a promising approach for some patients; however, the risk of radiation induced liver disease (RILD) remains a limiting factor for some patients. Thus, the discovery and validation of biomarkers to measure treatment response and toxicity is critical to make progress in personalizing radiotherapy for liver cancers. While tissue biomarkers are optimal, hepatocellular carcinoma (HCC) is typically diagnosed radiographically, making tumor tissue not readily available. Alternatively, blood-based diagnostics may be a more practical option as blood draws are minimally invasive, widely availability and may be performed serially during treatment. Possible blood-based diagnostics include indocyanine green test, plasma or serum levels of HGF or cytokines, circulating blood cells and genomic biomarkers. The albumin–bilirubin (ALBI) score incorporates albumin and bilirubin to subdivide patients with well-compensated underlying liver dysfunction (Child–Pugh score A) into two distinct groups. This review provides an overview of the current knowledge on circulating biomarkers and blood-based scores in patients with malignant liver disease undergoing radiotherapy and outlines potential future directions.

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Section: Circulating Blood Cellsmentioning

confidence: 68%

Section: Potential Prognostic Scores/biomarkersmentioning

confidence: 99%

Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers

Hauth

Roberts

Hong

et al. 2022

IJMS

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“… 11–14 The NLR cut-off was 1.9 according to a previous study. 15 Abdominal ultrasonography (US) and contrast-enhanced CT/MRI were used to evaluate cirrhosis, tumour diameter, number of tumours and presence of portal vein (PV) invasion. All patients were followed up by abdominal examination (US/CT/MRI) and assessments of AFP levels after the operation at intervals of 3–6 months.…”

Section: Methodsmentioning

confidence: 99%

Nomogram for the Preoperative Prediction of the Macrotrabecular-Massive Subtype of Hepatocellular Carcinoma

Shan¹,

Yu²,

Yang³

et al. 2022

JHC

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Background The macrotrabecular-massive subtype of hepatocellular carcinoma (MTM-HCC) is an aggressive histological type and results in poor prognosis. We developed a nomogram model based on laboratory results to predict the presence of MTM-HCC. Methods A total of 357 HCC patients who underwent radical surgery between January 2015 and December 2020 at Ningbo Medical Center Lihuili Hospital were grouped according to histological type. After propensity score matching (PSM), 267 patients were divided into MTM-HCC (n = 76) and non-MTM-HCC (n = 191) groups. A LASSO regression analysis model was used to select predictive factors. Finally, a nomogram for predicting the presence of MTM-HCC was established. Decision curve analysis (DCA) was conducted to determine the clinical usefulness of the nomogram model by quantifying the net benefits along with the increase in threshold probabilities. Results The 1-, 3-, and 5-year disease-free survival (DFS) and overall survival (OS) rates for MTM-HCC were 60.0%, 36.0%, 32.4% and 92.1%, 68.7%, 52.2%, respectively. Survival analysis indicated that the probabilities of achieving DFS and OS were significantly worse in the MTM-HCC group than in the non-MTM-HCC group ( P < 0.05). The nomogram model that included AST levels, PT and AFP levels achieved a better C-index of 0.723 (95% CI: 0.659–0.787). DCA revealed that the nomogram model could lead to net benefits and exhibited a wider range of threshold probabilities in the prediction of MTM-HCC. Conclusion The nomogram model included AST, PT and AFP could achieve an optimal performance in the preoperative prediction of MTM-HCC.

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“…The higher levels of NLR were consistently associated with decreased survival with ICIs, possibly due to increased inflammatory pressure leading to immune exhaustion; however, the cutoffs for NLR and patient cohorts were very variable [ 21 , 22 , 23 , 24 , 25 ]. Additionally, the dynamic changes in NLR could reflect the changes in the immune machinery in response to ICIs and could present a minimally invasive way to monitor the host earlier in the treatment course [ 26 , 27 , 28 ]. Considering the instrumental role of adaptive immune system as a driver of ICI efficacy, the exploitation of NLR as a prognostic biomarker has a strong biologic rationale [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy

Güven

Şahin

Erul

et al. 2022

JCM

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Dynamic changes in the blood-based biomarkers could be used as a prognostic biomarker in patients treated with immune checkpoint inhibitors (ICIs), although the data are limited. We evaluated the association between the neutrophil–lymphocyte ratio (NLR) and early NLR changes with survival in ICI-treated patients. We retrospectively evaluated the data of 231 patients with advanced-stage cancer. We recorded baseline clinical characteristics, baseline NLR and fourth-week NLR changes, and survival data. A compound prognostic score, the NLR2-CEL score, was developed with the following parameters: baseline NLR (<5 vs. ≥5), ECOG status (0 vs. ≥1), Charlson Comorbidity Index (CCI, <9 vs. ≥9), and fourth-week NLR change (10% or over NLR increase). In the multivariable analyses, higher NLR (HR: 1.743, p = 0.002), 10% or over NLR increase in the fourth week of treatment (HR: 1.807, p = 0.001), higher ECOG performance score (HR: 1.552, p = 0.006), higher LDH levels (HR: 1.454, p = 0.017), and higher CCI (HR: 1.400, p = 0.041) were associated with decreased OS. Compared to patients with the lowest scores, patients in the highest score group had significantly lower OS (HR: 7.967, 95% CI: 3.531–17.979, p < 0.001) and PFS. The composite score had moderate success for survival prediction, with an AUC of 0.702 (95% CI: 0.626–0.779, p < 0.001). We observed significantly lower survival in patients with higher baseline NLR values and increased NLR values under treatment.

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Dynamic Changes in Neutrophil-to-Lymphocyte Ratio are Associated with Survival and Liver Toxicity Following Stereotactic Body Radiotherapy for Hepatocellular Carcinoma

Cited by 10 publications

References 36 publications

Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers

Leveraging Blood-Based Diagnostics to Predict Tumor Biology and Extend the Application and Personalization of Radiotherapy in Liver Cancers

Nomogram for the Preoperative Prediction of the Macrotrabecular-Massive Subtype of Hepatocellular Carcinoma

The Association between Early Changes in Neutrophil-Lymphocyte Ratio and Survival in Patients Treated with Immunotherapy

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