A novel combined systemic inflammation-based score can predict survival of intermediate-to-advanced hepatocellular carcinoma patients undergoing transarterial chemoembolization

Abstract

Background: There is currently limited information regarding the prognostic ability of the dNLR-PNI (the combination of the derived neutrophil-to-lymphocyte ratio [dNLR] and prognostic nutritional index [PNI]) for hepatocellular carcinoma (HCC). This study aimed to assess the predictive ability of the dNLR-PNI in patients with intermediate-to-advanced HCC after transarterial chemoembolization (TACE).

Methods: A total of 761 HCC patients were enrolled in the study. The dNLR-PNI was retrospectively calculated in these patients, as follows: patients with both an elevated dNLR and a decreased PNI, as determined using the cutoffs obtained from receiver operating characteristic curve analysis, were allocated a score of 2, while patients showing one or neither of these alterations were allocated a score of 1 or 0, respectively.

Results: During the follow-up period, 562 patients died. Multivariate analysis suggested that elevated total bilirubin, Barcelona Clinic Liver Cancer C stage, repeated TACE, and dNLR-PNI were independently associated with unsatisfactory overall survival. The median survival times of patients with a dNLR-PNI of 0, 1, and 2 were 31.0 (95% confidence interval [CI] 22.5-39.5), 16.0 (95% CI 12.2-19.7) and 6.0 (95% CI 4.8-7.2) months, respectively (P < 0.001).

Conclusions: The dNLR-PNI can predict the survival outcomes of intermediate-to-advanced HCC patients undergoing TACE, and should be further evaluated as a prognostic marker for who are to undergo TACE treatment.

Keywords: Derived neutrophil-to-lymphocyte ratio (dNLR); Hepatocellular carcinoma (HCC); Prognostic nutritional index (PNI); Systemic inflammation; Transarterial chemoembolization (TACE).

Fig. 1

ROC analysis of the preoperative dNLR and PNI value for overall survival. a dNLR; b PNI

Fig. 2

The overall survival rates of the two groups according postoperative prognostic nutrition index. a the 1-, 3-, 5- year overall survival rates in group A are 49.7, 25.1 and 12.4%, respectively; b the 1-, 3-, 5- year overall survival rates in group dNLR < 1.7 are 69.0, 39.7 and 26.2%, respectively. And, the 1-, 3-, 5-year overall survival rates in group dNLR ≥1.7 are 39.2, 17.1 and 6.0% respectively (P < 0.001); c the 1-, 3-, 5- year overall survival rates in group PNI < 46 are 42.8, 19.3 and 8.2%, respectively. And, the 1-, 3-, 5-year overall survival rates in group PNI ≥ 46 are 59.0, 32.6 and 17.9% respectively (P < 0.001); d the 1-, 3-, 5- year overall survival rates in group dNLR-PNI 0 are 71.7, 44.5 and 32.9%, respectively. And, the 1-, 3-, 5-year overall survival rates in group dNLR-PNI 1 are 55.3, 27.0 and 12.4% respectively. And, the 1-, 3-, 5-year overall survival rates in group dNLR-PNI 2 are 34.1, 13.8 and 4.6% respectively (P < 0.001)

Fig. 3

Comparisons of the AUROC values for the survival status between the inflammation-based prognostic scores and the staging systems at overall survive. a 1 (b), 3 (c), and 5-years (d)