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. 2018 Feb 21;18(1):216.
doi: 10.1186/s12885-018-4121-3.

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

Chang Liu  1 , Lei Li  1 , Wu-Sheng Lu  2 , Hua Du  1 , Lu-Nan Yan  1 , Tian-Fu Wen  1 , Wu-Ran Wei  3 , Li Jiang  1 , Ming-Qing Xu  1
Affiliations

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

Chang Liu et al. BMC Cancer. .

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).

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board (IRB) of the West China Hospital, Sichuan University. Informed written consent was obtained from all individual participants included in the study. All the methods used in this study were carried out according to the approved guidelines.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
ROC analysis of the preoperative dNLR and PNI value for overall survival. a dNLR; b PNI
Fig. 2
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
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)
See this image and copyright information in PMC

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