Neutrophil-to-lymphocyte ratio predicts survival in European patients with hepatocellular carcinoma administered sorafenib

Abstract

Neutrophil-to-lymphocyte ratio (NLR) is considered a prognostic factor in patients with hepatocellular carcinoma (HCC). Our aim is to investigate the prognostic significance of NLR in patients with HCC treated with sorafenib.ResultsMedian follow-up time was 7 months. Patients were mostly in the intermediate (27.3%) or advanced (72.7%) BCLC stages, 38.6% had vascular invasion and 27.5% extrahepatic disease. A large proportion (38.9%) had been previously treated with TACE. Liver function was preserved: 65.8% were classed as Child A. Median overall survival was 7.7 months (95% CI: 5.8–9.6). In univariate analysis, vascular invasion (P = 0.004), ECOG-PS ≥ 1 (P < 0.001), high bilirubin (P < 0.001), clinical ascites (P = 0.036), BCLC stage (P = 0.004), no previous TACE (P = 0.041) and NRL ≥ 2.3 (P = 0.005) were predictors of poor survival. Skin toxicity (P = 0.039) or hypertension (P = 0.033) during treatment were related to better survival. In multivariate analysis NLR ≥ 2.3 [HR 1.72 (95% CI: 1.03–2.71)], hyperbilirubinemia [HR 3.42 (95% CI: 1.87–6.25)] and ECOG-PS ≥ 1 [HR 1.97 (95% CI: 1.19–3.26)] were found as independent indicators of poor overall survival. Dermatologic adverse effects were an indicator of good overall survival [HR 0.59 (95% CI: 0.38–0.92)].Material and MethodsOne hundred and fifty-four consecutive HCC patients treated with sorafenib in four different Spanish hospitals between August 2005 and October 2013 were analysed. Clinical, laboratory, and tumour features were obtained. Survival was calculated from the moment sorafenib treatment was initiated. Log-rank and Cox regression were used to analyse the ability of NLR to predict survival.ConclusionsNLR is an independent prognostic indicator for overall survival in HCC patients treated with sorafenib.

Neutrophil‐to‐lymphocyte ratio is associated with survival in patients with unresectable hepatocellular carcinoma treated with lenvatinib

“…Lué et al 27 reported that NLR ≥ 2.3 (HR, 1.72; 95% CI, 1.03‐2.71), bilirubin ≥ 2.0 mg/dL (HR, 3.42; 95% CI, 1.87‐6.25), Eastern Cooperative Oncology Group Performance status (ECOG‐PS) ≥ 1 (HR, 1.97; 95% CI, 1.19‐3.26) and absence of dermatologic adverse effects (HR, 0.59; 95% CI, 0.38‐0.92) are independently associated with overall survival based on multivariate analysis in 154 patients with HCC treated with sorafenib. In this study, we also found that NLR ≥ 4 (HR, 1.937; 95% CI, 1.183‐3.357) is independently associated with overall survival in patients with HCC treated with lenvatinib, a new molecularly targeted agent.…”

“…Several studies have suggested that elevated pretreatment NLR may be associated with poor outcomes in patients with HCC, 21–23 whereas other studies failed to detect such an association 24–26 . Regarding molecularly targeted therapy for HCC, several investigators have reported the utility of NLR as a predictor of survival in patients treated with sorafenib 27,28 . However, the association between NLR and prognosis in patients with unresectable HCC treated with lenvatinib has not been studied.…”

“…[24][25][26] Regarding molecularly targeted therapy for HCC, several investigators have reported the utility of NLR as a predictor of survival in patients treated with sorafenib. 27,28 However, the association between NLR and prognosis in patients with unresectable HCC treated with lenvatinib has not been studied.…”

Prognostic Roles of Blood Inflammatory Markers in Hepatocellular Carcinoma Patients Taking Sorafenib. A Systematic Review and Meta-Analysis

“…Three of them were prospective studies (21, 23, 31) and 16 were retrospective studies. The 194 patients in two studies (22,24) had intermediate-advanced HCC, and 2,551 patients in the remaining studies were in the advanced stage of the disease. Eight studies were conducted in Asia, mainly in China and Japan, 8 studies were conducted in America and Europe, and two were multicentered covering locations in western and eastern countries (17,21).…”

Retrospective analysis of the immunogenic effects of intra-arterial locoregional therapies in hepatocellular carcinoma: a rationale for combining selective internal radiation therapy (SIRT) and immunotherapy

“…In this context, the use of immunotherapy appears to be an attractive option. Several studies have indicated that HCCs are immunogenic and immunosensitive tumors and promising results have been obtained with different types of immunotherapy, including adoptive immunotherapy and checkpoint inhibitors [8][9][10][11][12][13][14][15][16][17][18]. However, in individual patients, the overall results of immunotherapy remain inconsistent and outcomes are difficult to predict.…”