Analysis Of Prognostic Value Of NLR And PLR In Patients With Liver Cancer Treated With PD-1 Inhibitors

BackgroundPrimary liver cancer(hereinafter referred to as liver cancer)refers to a malignant tumor that occurs in hepatocytes or intrahepatic bile duct cells.The main histological type is hepatocellular carcinoma,accounting for about 85%-90% of the total number of liver cancers,which is one of the deadliest malignant tumors in the world.Surgical resection is the first choice for the treatment of liver cancer,but most patients have no obvious symptoms in the early stage.Once jaundice,emaciation and other symptoms appear,it shows that they have entered the middle and late stage,and only a small number of patients are suitable for operation.The efficacy of local ablation,interventional embolization,systemic chemotherapy and radiotherapy is very limited.Targeted therapy such as sorafenib and lamvatinib are the "gold standard" drugs for the treatment of advanced liver cancer in recent years,but a large number of patients have reduced or stopped taking drugs because of serious adverse reactions.Immunotherapy for liver cancer is a new biological therapy,which can kill tumor cells by stimulating the immune function of the human body,and improve the curative effect on liver cancer to a certain extent.In recent years,more and more studies have shown that chronic inflammation can promote the occurrence and development of tumors,and the degree of systemic inflammation is considered to be related to the prognosis of tumors.Some studies have found some parameters related to the prognosis of cancer patients,such as neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)and so on.Related studies have shown that inflammatory indexes such as NLR and PLR can predict the prognosis of lung cancer,breast cancer,esophageal cancer,gastric cancer,liver cancer and other cancers.At present,there are rare reports at home and abroad to explore the prognostic value of these inflammatory markers in patients with liver cancer treated with programmed cell death protein-1(PD-1)inhibitors.ObjectiveThe purpose of this study was to explore the prognostic value of NLR and PLR in predicting the prognosis of patients with liver cancer treated with PD-1 inhibitors.MethodsThe clinical data of 102 patients with liver cancer treated with PD-1 inhibitors in the People’s Hospital of Henan University from June 2018 to December 2019 were analyzed retrospectively.Collect the blood routine results of the patients within one week before receiving PD-1 inhibitor treatment and calculate the NLR and PLR,using the receiver operating characteristic(ROC)curve to calculate the Jordan index of NLR and PLR before PD-1 inhibitor treatment,and calculate the best cut-off point.According to the cutoff points of NLR and PLR,the patients were divided into low NLR group and high NLR group,low PLR group and high PLR group.The relationship between NLR,PLR,clinical features and prognosis before PD-1 inhibitor treatment was analyzed.The cumulative survival rate was calculated by Kaplan-Meier method,and the survival curve was drawn.Log-rank test was used to compare the survival differences among different groups.Finally,COX multivariate proportional regression model was used to analyze the independent prognostic factors affecting progression-free survival(PFS)in patients with liver cancer.The difference was statistically significant(P < 0.05).ResultsThe ROC curve was drawn according to the NLR value of PD-1 inhibitor before treatment,the area under the curve was 0.732,the maximum Yoden index was 0.380,thecorresponding NLR cutoff value was 2.84,the sensitivity was 72.9%,and the specificity was 65.1%.The ROC curve was drawn according to the PD-1 inhibitor before treatment,the area under the curve was 0.738,the maximum Jordan index was 0.365,the corresponding PLR cutoff value was 132.27,the sensitivity was 64.4%,and the specificity was 72.1%.There were 44 cases in NLR < 2.84 group and 58 cases in NLR ≥2.84 group.There was no significant difference in sex,age,hepatits B surface antigen(HBs Ag),Chlid-Pugh grade,alanine aminotransferase(ALT)and aspartate aminotransferase(AST)between the two groups,but the level of alpha fetoprotein(AFP)was statistically significant.There were 52 cases in PLR < 132.27 group and 50 cases in PLR ≥132.27 group.There was no significant difference in sex,age,HBs Ag,Chlid-Pugh grade,ALT level and AST level,but there was statistical significance in AFP level.Log-rank univariate analysis showed that the levels of NLR,PLR and AFP before treatment with PD-1 inhibitors were all risk factors for the prognosis of patients with liver cancer treated with PD-1 inhibitors.The significant variables in univariate analysis were included in COX multivariate regression.The results showed that the level of NLR before PD-1 inhibitor treatment was an independent risk factor for the prognosis of patients with liver cancer.Conclusion1.For patients with liver cancer,the peripheral blood NLR of 2.84 and PLR of 132.27 before PD-1 inhibitor treatment can be used as the critical value for the prognosis of liver cancer patients,and the prognosis is poor when the value is higher than the critical value,and the predictive effect of NLR is better than that of PLR.2.NLR was not correlated with age,sex,HBs Ag,Child-Pugh grade,ALT level and ASTlevel,but correlated with AFP level.PLR was not correlated with age,sex,HBs Ag,Child-Pugh grade,ALT level and AST level,but correlated with AFP level.3.The levels of NLR,PLR and AFP before PD-1 inhibitor treatment are related to the prognosis of liver cancer patients treated with PD-1 inhibitor.4.PD-1 inhibitor treatment is an independent risk factor for PFS in patients with liver cancer.