Prognostic Value of the Preoperative Neutrophil–Lymphocyte Ratio Combined with Fibrinogen in Patients with Unresectable Hepatocellular Carcinoma undergoing Transarterial Embolization

Background Elevated plasma fibrinogen (Fib) levels and a high preoperative neutrophil–lymphocyte ratio (NLR) are known to be associated with poor outcomes in hepatocellular carcinoma (HCC) patients. Herein, we investigated the prognostic value of the combined NLR–Fib grade in patients with unresectable HCC.

Methods A total of 544 patients with newly diagnosed HCC were retrospectively evaluated. The NLR-Fib was scored as follows: patients in whom both the NLR and Fib were elevated according to receiver operating characteristic curve analysis were assigned a score of 2; patients with 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 parameters associated with overall survival (OS).

Results Higher NLR–Fib grades were associated with worse hepatic function, larger tumor size, and presence of vascular invasion. Patients with NLR–Fib 0 showed the best survival, with a median OS of 43 months (95% confidence interval [CI] 27.6–58.4 months), as compared with patients with NLR–Fib 1 (median OS, 18 months; 95% CI 11.0–24.9 months) and NLR–Fib 2 (median OS, 6 months; 95% CI 4.9–7.1 months) (p < 0.05). On multivariate analysis, aspartate transaminase (>35 IU/L), Barcelona Clinic Liver Cancer C stage, and NLR–Fib (grades 1 and 2) independently associated with OS.

Discussion High pretreatment NLR–Fib was associated with tumor progression and poor prognosis in patients with unresectable HCC after transarterial chemoembolization.