Prognostic Value of Inflammation Scores in Liver Cancer Post Transarterial Chemoembolization

Purpose Both the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) reflect systematic inflammatory status. These values can be conveniently obtained from routine blood tests; however, their combined usefulness has not been extensively studied in patients with hepatocellular carcinoma (HCC). This study aimed to investigate the prognostic value of NLR–PLR in patients with intermediate-to-advanced HCC who underwent transarterial chemoembolization (TACE).

Materials and Methods In total, 760 patients with newly diagnosed HCC were retrospectively evaluated. The NLR–PLR was scored as follows: patients in whom both the NLR and PLR were 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. Univariate and multivariate analyses were performed to identify the clinic-pathological variables associated with overall survival.

Results The NLR–PLR consistently had a higher area under the curve value at 1 year (0.698), 3 years (0.679), and 5 years (0.658) compared with either NLR or PLR alone. Patients with NLR–PLR scores of zero had the most favorable outcomes, with a median overall survival (OS) of 27 months (95% confidence interval [CI], 21.5–32.5 months) compared with patients in the NLR–PLR 1 category (median OS, 15 months; 95% CI, 11.2–18.8 months) and the NLR–PLR 2 category (median OS, 6 months; 95% CI, 9.7–14.3 months; p < 0.005). Multivariate analysis showed that the NLR–PLR, elevated total bilirubin, Barcelona Clinic Liver Cancer C stage, and vascular invasion were independently associated with overall survival.

Conclusion This study demonstrates that the NLR–PLR, when combined to produce an inflammation-based prognostic score, is an independent marker of poor prognosis in patients with HCC who underwent 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) PLR; (D) NLR-PLR. dNLR, derived neutrophil-to-lymphocyte ratio; HCC, hepatocellular carcinoma; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio.