Neutrophil-to-lymphocyte and aspartate-to-alanine aminotransferase ratios predict hepatocellular carcinoma prognosis after transarterial embolization

Abstract

The neutrophil-to-lymphocyte ratio (NLR) reflects the systematic inflammatory status, and the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) is a biomarker of liver fibrosis and cirrhosis. These values can be conveniently obtained from routine blood tests; however, their combined clinical utility has not been extensively studied in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). This study aimed to investigate the prognostic value of NLR-AAR in patients with unresectable HCC undergoing TACE. Data for 760 patients with newly diagnosed HCC were retrospectively evaluated. The NLR-AAR was calculated as follows: patients in whom both the NLR and AAR were elevated according to the receiver operating characteristic (ROC) curve analysis were assigned a score of 2; patients showing an elevation in one or neither of these indicators were assigned a score of 1 or 0, respectively. Univariate and multivariate analyses were performed to identify the clinicopathological variables associated with overall survival. An ROC curve was also generated and the area under the curve (AUC) was calculated to evaluate the discriminatory ability of each index at 1, 3, and 5 years of follow-up, as well as overall. The NLR-AAR consistently had a greater AUC value at 1 year (0.669), 3 years (0.667), and 5 years (0.671) post-TACE compared with either NLR or AAR alone. The median survival times of patients with a NLR-AAR of 0, 1, and 2 were 31.0 (95% confidence interval [CI] 24.0–38.0), 15.0 (95% CI 11.2–18.8), and 5.0 (95% CI 4.0–5.9) months, respectively (P < .001). Multivariate analysis showed that the NLR-AAR, elevated total bilirubin level, and vascular invasion were independently associated with overall survival. NLR and AAR, when combined to produce an inflammation-based index and fibrosis score, is an independent marker of poor prognosis in patients with HCC receiving TACE.

<p>The prognostic and predictive value of the combination of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma who receive transarterial chemoembolization therapy</p>

“…However, CRP and ALP were both excluded after the multivariate analysis, indicating that the NLR–PLR score was a more powerful predictor than CRP and ALP and was representative as an inflammation-based prognostic factor in patients with HCC, compared with other inflammation-based factors. There were some previous studies which focused on inflammation-based factors,58,59 such as NLR and PLR in HCC patients after TACE therapy, while they only discussed the prognostic effect of a single factor. Similarly, in our study, the Kaplan–Meier analysis showed that elevated NLR or PLR was associated with poor OS, these parameters were suboptimal for predicting OS.…”

Prognostic significance of inflammatory indices in hepatocellular carcinoma treated with transarterial chemoembolization: A systematic review and meta-analysis

“…A total of 22 studies [2,5,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] published between 2011 and 2019 were identified and all these trials were retrospective cohort studies with 5280 patients enrolled in this meta-analysis. The basic characteristics of the included studies were summarized and presented in Table 1.…”

“…Sample sizes ranged from 49 to 921. Of the 22 studies, 16 of studies [2,5,19,21,[23][24][25][27][28][29][30][31][32][33][34]37] were about the prognostic value of preoperative NLR for OS, 5 about PLR [23,24,26,32,33] and 6 about CRP [20,22,33,35,36,38]. The NLR cut-off values in these studies were determined by different methods and ranged from 1.77 to 5.…”

Neutrophil-to-lymphocyte ratio predicts diagnosis and prognosis of patients with hepatocellular: A systematic review and meta-analysis

“…For quality assessment of included study, baseline data of these studies were extracted and exhibited in Table 1. Regions of these 9 studies were all from East Asian with 7 from mainland China [34][35][36][37][38][39][40], 1 from Korea [41] and 1 from Taiwan [42]. All these studies were single-center trials published from 2012 to 2018.…”