Neutrophil-lymphocyte Ratio Plus Prognostic Nutritional Index Predicts the Outcomes of Patients with Unresectable Hepatocellular Carcinoma After Transarterial Chemoembolization

Liu, Chang; Li, Lei; Lu, Wusheng; Du, Hong; Yan, Lü-Nan; Yang, Jiayin; Wen, Tianfu; Zeng, Guojun; Jiang, Li; Yang, Jian

doi:10.1038/s41598-017-13239-w

Cited by 22 publications

(22 citation statements)

References 25 publications

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“…All TACE procedures were performed by two operators using the same angiographic system (Allura Xper FD20, Philips Healthcare), which has been previously described [ 12 ]. Briefly, treatment with TACE was performed with a standard protocol under local anesthesia by 5-fluorouracil (800–1000 mg) and epirubicin-adriamycin (30–40 mg) followed with lipiodol (Lipiodol Ultra-Fluide; Andre Guerbet Laboratories, France) and polyvinyl alcohol foam embolization particles (100–500 μm in diameter; Cook, Bloomington, IN, USA).…”

Section: Methodsmentioning

confidence: 99%

A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization

Liu

et al. 2018

BMC Cancer

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BackgroundThere is currently limited information regarding the prognostic ability of the dNLR-PNI (the combination of the derived neutrophil-to-lymphocyte ratio [dNLR] and prognostic nutritional index [PNI]) for hepatocellular carcinoma (HCC). This study aimed to assess the predictive ability of the dNLR-PNI in patients with intermediate-to-advanced HCC after transarterial chemoembolization (TACE).MethodsA total of 761 HCC patients were enrolled in the study. The dNLR-PNI was retrospectively calculated in these patients, as follows: patients with both an elevated dNLR and a decreased PNI, as determined using the cutoffs obtained from receiver operating characteristic curve analysis, were allocated a score of 2, while patients showing one or neither of these alterations were allocated a score of 1 or 0, respectively.ResultsDuring the follow-up period, 562 patients died. Multivariate analysis suggested that elevated total bilirubin, Barcelona Clinic Liver Cancer C stage, repeated TACE, and dNLR-PNI were independently associated with unsatisfactory overall survival. The median survival times of patients with a dNLR-PNI of 0, 1, and 2 were 31.0 (95% confidence interval [CI] 22.5–39.5), 16.0 (95% CI 12.2–19.7) and 6.0 (95% CI 4.8–7.2) months, respectively (P < 0.001).ConclusionsThe dNLR-PNI can predict the survival outcomes of intermediate-to-advanced HCC patients undergoing TACE, and should be further evaluated as a prognostic marker for who are to undergo TACE treatment.

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Section: Methodsmentioning

confidence: 99%

A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization

Liu

et al. 2018

BMC Cancer

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“…Published data revealed that these low cost inflammation-based markers including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI) are associated with prognostic significance in patients with HCC 10 – 13 . The elevated NLR was correlated with worse prognosis in HCC patients treated by RFA 13 , surgical resection 14 , transplantation 15 , and transcatheter arterial chemoembolization (TACE) 16 . A combination of the NLR and the PLR is a useful predictor for recurrence and prognosis in patients with HCC post RFA 17 .Another marker is the PNI, a combination of the serum albumin concentration and total lymphocyte count.…”

Section: Introductionmentioning

confidence: 99%

Pretreatment Inflammation-Based Markers Predict Survival Outcomes in Patients with Early Stage Hepatocellular Carcinoma After Radiofrequency Ablation

Chu

Shen

Chang

et al. 2018

Sci Rep

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The prognostic significance of various systemic inflammation‐based markers has been explored in different cancers after surgery. This study aimed to investigate whether these markers could predict outcomes in patients with early-stage hepatocellular carcinoma (HCC) undergoing radiofrequency ablation (RFA). One hundred eighteen patients with newly diagnosed HCC within the Milan criteria receiving RFA as initial therapy were retrospectively enrolled. Pretreatment inflammation-based markers including the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and prognostic nutritional index (PNI), together with other clinicopathologic parameters were collected. Cumulative overall survival (OS) and recurrence-free survival (RFS) were estimated by the Kaplan-Meier method and by multivariate analysis using Cox proportional hazard model. The 1-, 3-, and 5-year OS rates of patients were 90%, 67%, and 52%, respectively. Kaplan-Meier curves showed that baseline high NLR ≥ 2.5 (p = 0.006), low PNI < 40 (p = 0.005), history of end-stage renal disease (ESRD) (p = 0.005), non-Child-Pugh class A (p = 0.001) and elevated alpha-fetoprotein (AFP) ≥ 200 ng/mL (p = 0.005) significantly associated with the poor OS, whereas high PLR ≥ 100 did not. By multivariate analysis, high NLR ≥ 2.5 (hazard ratio (HR) 1.94; 95% confidence interval (CI), 1.05–3.59; p = 0.034), low PNI < 40 (HR 0.38; 95% CI, 0.20–0.72; p = 0.003), ESRD history (HR 3.60; 95% CI, 1.48–8.76; p = 0.005) and elevated AFP ≥ 200 ng/mL (HR 4.61; 95% CI, 1.75–12.13; p = 0.002) were independent factors. An elevated AFP level of ≥200 ng/mL was the significant factor associated with intrahepatic new RFS by univariate and multivariate analyses. In conclusion, pretreatment NLR and PNI are simple and useful predictors for OS in patients with early-stage HCC after RFA.

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“…Liu et al (2017) [26] who was the first one evaluated the ability of the combined NLR-PNI score to predict the outcomes of patients with early stage HCC after RFA and reported that after dividing their patients into three groups according to NLR-PNI scores, those patients with high combined scores had progressively worse outcomes relative to those with lower scores, and these differences were largely significant.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil to Lymphocyte Ratio as Predictive Marker of Recurrence of HCC after Radiofrequency Ablation

Rahman¹,

El-Senosy²,

Alsebaey³

et al. 2019

AJCMR

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Background: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are immunonutritional indices, have been shown as an independent factor to predict postoperative recurrence and/or overall survival in patients with hepatocellular carcinoma (HCC). Aim: to validate neutrophils-to-lymphocytes ratio (NLR) as a predictor of post radiofrequency ablation recurrence of hepatocellular carcinoma (HCC). Patients and methods: This cross sectional prospective study was conducted on 50 Egyptian patients had radiofrequency ablation for HCC within Barcelona clinical liver cancer (BCLC) stage A. Pre-treatment laboratory tests and imaging were used to measure NLR, PLR, PNI, Child-Pugh (CTP score, tumor number and tumor size. HCC recurrences were followed after three month. Results: According to NLR cutoff value, the patients with NLR >1.73 had larger tumour size, and higher rates of tumor multiplicity .After 3 month follow up 30/50 (60%) patients had tumour recurrence. Regarding recurrence after RFA showed that CTP class B (P<0.05), tumor size (P<0.05), higher rates of tumor multiplicity (P<0.05), decrease PNI (P<0.001) and increased NLR (P<0.05) after RFA and at baseline were found to be worse prognosis. A receiver-operating characteristic (ROC) analysis was used to classify patients as follows: NLR-PNI 0 group (NLR≤1.73 and PNI > 11.74), NLR-PNI 1 group (NLR > 1.73 or PNI ≤ 11.74) and NLR-PNI 2 group (NLR > 1.73 and PNI ≤ 11.74). The patients with NLR-PNI 2 group had increase in number of portahepatis lymph node, number and size of tumor, decrease serum albumin and change in PNLR. Multivariate analyses suggested increased NLR (hazard ratio [HR] =2.09; 95% confidence interval [CI] =1.88-2.55; P<0.05), increased PLR (HR=0.07; 95% CI=0.06-0.08; P<0.05), and increased AFP (HR=59.20; 95% CI=-99.74-638.78; P<0.05) contributed to post-RFA mortality. Conclusion: High blood NLR after RFA is a predictor for worse survival and also can predict recurrence of HCC. Higher NLR-PNI score predict a worse prognosis in patients who underwent RFA.

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Neutrophil-lymphocyte Ratio Plus Prognostic Nutritional Index Predicts the Outcomes of Patients with Unresectable Hepatocellular Carcinoma After Transarterial Chemoembolization

Cited by 22 publications

References 25 publications

A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization

A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization

Pretreatment Inflammation-Based Markers Predict Survival Outcomes in Patients with Early Stage Hepatocellular Carcinoma After Radiofrequency Ablation

Neutrophil to Lymphocyte Ratio as Predictive Marker of Recurrence of HCC after Radiofrequency Ablation

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