Neutrophil-to-Lymphocyte and Aspartate-to-Alanine Aminotransferase Ratios Predict Hepatocellular Carcinoma Prognosis after Transarterial Embolization

Purpose 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.

Materials and Methods 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 curve (ROC) 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 clinical and pathological 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.

Results The NLR–AAR consistently had a greater area under the curve 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 an 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 < 0.001). Multivariate analysis showed that the NLR–AAR, elevated total bilirubin level, and vascular invasion were independently associated with overall survival.

Conclusion 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.

Fig. 1 Kaplan–Meier survival curves for overall survival in HCC patients undergoing transarterial chemoembolization for hepatocellular carcinoma. (A) Overall survival; (B) NLR; (C) AAR; and (D) NLR-AAR. AAR, aspartate aminotransferase-to-alanine aminotransferase ratio; HCC, hepatocellular carcinoma; NLR, neutrophil-to-lymphocyte ratio.