| Background and objectives:Transarterial chemoembolization(TACE)is recommended by most guidelines as a first-line treatment for intermediated(Barcelona Clinic Liver Cancer Stage B,BCLC B)hepatocellular carcinoma(HCC).However,not all inter-mediated HCC patients will benefit from TACE monotherapy which is associated with high risk of postoperative tumor recurrence and metastasis,and liver function damage.Recently,intermediated HCC patients who underwent the combination of TACE and microwave ablation(MWA)treatment had better tumor response and longer overall survival(OS)compared to those underwent TACE monotherapy.Nevertheless,favorable prognostic factors are still lacking in HCC patients treated by TACE with MW A.This study aimed to explore evaluation of the neutrophil to lymphocyte ratio(NLR)and its variation in predicting prognosis in inter-mediated HCC patients treated by TACE with MWA.Materials and Methods:This study retrospectively consisted of 71 treatment-naive inter-mediated HCC patients underwent TACE with MWA treatment from September,2014 to December,2018.Neutrophil and lymphocyte counts were recorded in all patients within 7 days before TACE,3 days after TACE,3 days before MWA,and 7 days after MWA.All patients were divided into high or low NLR group before treatment and high or low NLR group after treatment.By comparing the NLR values after MWA to those before TACE,the patients were divided into NLR increasing and decreasing group.The primary endpoint of this study was the progression-free survival(PFS),and the secondary endpoint was the tumor response in 1 month,3 months,and 6 months after the combination therapy.PFS is defined as the period from the date of TACE procedure to the patient’s disease progression or death.According to the modified response evaluation criteria in solid tumors(mRECIST)criteria,the tumor response was assessed.Xtile was used to calculate the cut-off values of NLR before and after the combination treatment.The baseline characteristics,tumor response and survival analysis of patients in the three groups were compared.Kaplan-Meier survival analysis and log-rank test were used to compare the PFS among the different groups.Patients’ baseline characteristics and NLR were taken as the dependent variables,and patients’ disease progression or death status and PFS were taken as the dependent variables.The analysis of independent prognostic factors related to PFS was carried out using univariate and multivariate COX regression models.Results:1)Baseline characteristics:71 patients including 52 males and 19 females were enrolled,with an average age of 63.04±1.21 years.The median follow-up time was 29.8(95CI:20.2-39.4)months,and the median PFS of the entire set was 18.3(95%CI:14.7-22.9)months.2)NLR cut-off values before and after treatment:The NLR cut-off values before and after treatment were calculated by Xtile software as 3 and 2.4,respectively.3)Comparison of Baseline characteristics between high and low NLR group before treatment:the proportion of cirrhosis in patients with high NLR(25/31 vs.21/40,P=0.02),the proportion of tumor number>3(17/31 vs.5/40,P<0.001),the proportion beyond the up-to-7 criteria(10/31vs.2/40,P=0.003)and tumor size(P=0.015)were significantly higher than those in low NLR group.4)Comparison of PFS between the high/low NLR group before and after treatment and increasing/decreasing NLR groups:PFS of the NLR decreasing group was significantly longer than that of the increasing NLR group,(21.4(95%CI:11.7-31.1)vs.12.3(95%CI:7.2-17.3)months,P=0.009).The 1-year and 2-year PFS rates of the decreasing NLR group were 96.7%and 48.0%,while those of the increasing NLR group were 53.7%and 28.9%.There was no significance of the PFS in the high NLR group and low NLR group before and after treatment,respectively(20.5,(95%CI:16.8-24.3)vs.17.0,(95%CI:10.0-24.0),P=0.485;18.2,(95%CI:13.3-23.1)vs.21.0,(95%CI:1.7-40.2),P=0.109).5)Efficacy evaluation of patients in the groups with high and low NLR before TACE and those with increased and decreased NLR:ORR in the low NLR group at 1,3 and 6 months was significantly higher than that in the high NLR group(P=0.0004,P=0.0005,P=0.001).ORR at 6 months was significantly higher in the NLR decreased group than in the NLR increased group(P=0.02).6)Prognostic factors:Increased NLR(HR=2.659,95%CI:1.369-5.165,P=0.004)and AST>40 U/L(HR=1.981,95%CI:1.060-3.703,P=0.032)were independent poor prognostic factors for patients with inter-mediated HCC.Conclusions:Compared with the NLR values before and after the combination treatment,monitoring the dynamic changes of NLR before and after treatment could had a more accurate predicting performance in inter-mediated HCC patients treated by TACE with MWA.With less cost,the variation of NLR could serve as a favorable biomarker in order to identify HCC patients who will benefit from such a combination therapy,and it is worth promotion in routine practice. |
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