Combined Inflammation-based Index Predicts Outcomes of Hepatocellular Carcinoma Treated with Transarterial Embolization
22 March 2018 (online)
Purpose The neutrophil-to-lymphocyte ratio (NLR) reflects systematic inflammatory status, while the aspartate aminotransferase/platelet count ratio index (APRI) is considered a biomarker of liver fibrosis and cirrhosis. Their combined usefulness has not been studied in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). The study aims to investigate the prognostic value of the combined NLR–APRI in patients with intermediate-to-advanced hepatitis B virus-related HCC treated with TACE.
Materials and Methods A total of 638 patients with HCC were retrospectively evaluated. The NLR-APRI was scored as follows: patients with both the NLR and APRI elevated according to receiver operating characteristic curve analysis were assigned a score of 2; patients showing elevation in one or neither of these indicators were assigned a score of 1 or 0, respectively.
Results The NLR–APRI consistently had a higher area under the curve value at 1 year (0.666), 3 years (0.657), and 5 years (0.643) compared with either NLR or APRI alone. Patients with NLR–APRI scores of zero had the most favorable outcomes, with a median OS of 31 months (95% confidence interval [CI], 18.4–43.6 months), as compared with the NLR–APRI 1 (median OS, 14 months; 95% CI, 11.0–16.9 months) and NLR–APRI 2 groups (median OS, 5 months; 95% CI, 4.0–5.9 months). Multivariate analysis showed that the NLR–APRI, elevated total bilirubin, Barcelona Clinic Liver Cancer C stage, and vascular invasion were independently associated with overall survival.
Conclusion When combined to produce an inflammation-based index and fibrosis score, NLR–APRI is an independent marker of poor prognosis in patients with HCC treated with TACE.