Cancers:中性粒细胞/淋巴细胞比(NLR)是中期肝细胞癌(HCC)患者一线接受TACE治疗的预后指标。

2021-06-07 yd2015 MedSci原创

中性粒细胞/淋巴细胞比(NLR)是中期肝细胞癌(HCC)患者一线接受TACE治疗的预后指标,并且高NLR提示较差的生存。

肝细胞癌(HCC)是常见的恶性肿瘤之一,其预后较差。经肝动脉栓塞化疗(TACE)是常用治疗手段。中性粒细胞/淋巴细胞比(NLR)是一种系统免疫标志物,其预后价值在多种肿瘤中都有研究。中性粒细胞可以促进癌变,血管生成,促进肿瘤细胞运动,从而导致肿瘤侵袭和转移。而淋巴细胞缺乏影响抗肿瘤应答,通常跟肿瘤患者较差预后相关。但是NLR在中期HCC患者中接受TACE治疗的预后价值尚不清楚。因此,来自韩国的研究团队开展了一项回顾性研究,评估初始未治疗的中期HCC患者,一线接受TACE治疗NLR的预后价值。相关结果发表在Cancers杂志上。

该研究回顾性纳入2008年至2017年初始未治疗的,一线接受TACE治疗的中期HCC患者。2013年之前的患者分配为研究队列,2013年之后的患者分配为验证队列。主要研究终点为NLR与OS的关系(对相关因素进行调整后)。次要终点为NLR与TACE治疗后6个月的应答。研究最终纳入931例患者,其中研究队列495例患者,而验证队列436例患者。除年龄外,两队列的基本特征类似。

                研究概况

整体人群中中位随访时间为31个月(IQR, 16.3–52.2 months),中位OS为31.1个月(95% CI, 28.5–33.7 months)。1,3,5,和10年OS率分别为81.7%, 45%, 28.2%, 和 14.6%。多变量Cox回归分析发现,肿瘤直径>5厘米(HR=1.30;95%CI,1.06-1.61;P=0.013),肿瘤数目≥4(HR=1.67;95%CI,1.35-2.05;p<0.001),肿瘤类型(HR=2.28;95%CI,1.73-3.01;P<0.001)、AFP≥200 ng/mL (HR= 1.23;95%CI,1.01-1.50;p = 0.042),NLR≥3 (HR=1.41;95%CI,1.10-1.81;p = 0.007),Child-Pugh B (HR=1.66;95%CI,1.24-2.23;p<0.001)与TACE术后的OS率显著相关。根据这六个变量构建预测模型,进行风险评分,分为0–3, 4–7,和8–12分,对应低危,中危和高危组。研究队列低、中、高危组的中位OS时间分别为40.8个月(95% CI, 35.2-46.4个月)、18.9个月(95% CI, 16.2–21.6个月)和 7.1个月(95% CI, 4.9-9.3个月),而验证队列的中位OS分别为48.1个月(95% CI, 42.1-54.1个月),24.3个月(95% CI,19.4-29.2个月和9.7个月(95% CI, 5.1-14.3个月)。 OS率随着风险评分的增加而逐渐降低,在低中危组和中高危组人群之间差异有统计学意义(p≤0.001)。

            研究和验证队列不同风险组的OS

预测模型用于验证队列进行时间依赖的ROC曲线分析时,3和5年的AUC值分别为0.72 (95% CI, 0.67–0.77) 和 0.70 (95% CI, 0.63–0.77)。

                    3年和5年ROC曲线

整体人群中,基线NLR< 3的患者中位生存期为34.9个月,明显优于NLR ≥ 3的患者(16.7个月),两组有统计学差异(p < 0.001)。

               总体人群NLR比值对OS影响

多变量Cox回归分析发现,肿瘤直径>5厘米(OR=2.18; 95% CI, 1.53–3.10; p < 0.001),肿瘤数目≥4(OR=3.44; 95% CI, 2.37–4.98; p < 0.001),肿瘤类型(OR=3.44; 95% CI, 2.37–4.98; p < 0.001)、AFP≥200 ng/mL (OR=3.44; 95% CI, 2.37–4.98; p < 0.001)和NLR≥3 (OR=3.35; 95% CI, 2.27–4.94; p < 0.001)与TACE术后6个月进展显著相关。

            TACE治疗6个月PD的相关因素

综上,中性粒细胞/淋巴细胞比(NLR)是中期肝细胞癌(HCC)患者一线接受TACE治疗的预后指标,并且高NLR提示较差的生存。

原始出处:

Chu, H.H.; Kim, J.H.; Shim,J.H.; et al. Neutrophil-to-Lymphocyte Ratio as a Biomarker Predicting Overall Survival after Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma. Cancers 2021, 13, 2830. https://doi.org/10.3390/cancers13112830.

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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407764, encodeId=f48d140e764e9, content=<a href='/topic/show?id=a22412862b3' target=_blank style='color:#2F92EE;'>#NLR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12862, encryptionId=a22412862b3, topicName=NLR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cd32710930, createdName=yuandd, createdTime=Wed Jun 09 02:17:44 CST 2021, time=2021-06-09, status=1, ipAttribution=)]
    2021-08-20 grace5700
  4. 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    2022-05-11 anminleiryan
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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407764, encodeId=f48d140e764e9, content=<a href='/topic/show?id=a22412862b3' target=_blank style='color:#2F92EE;'>#NLR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12862, encryptionId=a22412862b3, topicName=NLR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cd32710930, createdName=yuandd, createdTime=Wed Jun 09 02:17:44 CST 2021, time=2021-06-09, status=1, ipAttribution=)]
    2022-01-09 xjy02
  6. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407764, encodeId=f48d140e764e9, content=<a href='/topic/show?id=a22412862b3' target=_blank style='color:#2F92EE;'>#NLR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12862, encryptionId=a22412862b3, topicName=NLR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8cd32710930, createdName=yuandd, createdTime=Wed Jun 09 02:17:44 CST 2021, time=2021-06-09, status=1, ipAttribution=)]
    2021-06-09 jiyangfei
  7. 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  8. 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  9. 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