Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;46(1):49-59.
doi: 10.1007/s00270-022-03288-8. Epub 2022 Sep 30.

Retrospective Evaluation and Significance of Neutrophil-to-Lymphocyte Ratio Prior to and 1 month Following Microwave Ablation of Hepatocellular Carcinoma

Angelo Della Corte  1   2   3 , Claudio Sallemi  4 , Francesca Ratti  5 , Lorenzo Monfardini  4 , Simone Gusmini  6 , Federica Cipriani  5 , Renato Pennella  6 , Domenico Santangelo  6 , Valentina Burgio  7 , Andrea Casadei-Gardini  8   7 , Luca Aldrighetti  8   5 , Francesco De Cobelli  6   9   8
Affiliations

Retrospective Evaluation and Significance of Neutrophil-to-Lymphocyte Ratio Prior to and 1 month Following Microwave Ablation of Hepatocellular Carcinoma

Angelo Della Corte et al. Cardiovasc Intervent Radiol. 2023 Jan.

Abstract

Purpose: Neutrophil-to-lymphocyte ratio (NLR) recently demonstrated predictive value for hepatocellular carcinoma (HCC) recurrence after thermal ablation. Microwave ablation (MWA) has been shown to induce changes in the immune landscape after HCC treatment. This study aims at identifying predictors of local tumor progression (LTP) and post-treatment NLR kinetics after MWA.

Materials and methods: Data from 108 consecutive patients who underwent percutaneous MWA of 119 HCCs with a 2450 Hz/100 W generator in two institutions from October 2014 to September 2021 were retrospectively reviewed. Forty-five HCCs (42 patients) met inclusion criteria for analysis (technique efficacy, pre- and post-treatment NLR availability, follow-up > 6 months, absence of complications). NLR was analyzed prior to therapy and at 1-month follow-up; difference between the two time points was defined as ΔNLR1stFU.

Results: After a median follow-up of 25 months, LTP occurred in 18 HCCs (40%) and 18 patients (42.9%). Multivariate competing risk regression comprising ΔNLR1stFU > 0, cirrhosis etiology and subcapsular location showed that the only independent predictor of LTP was ΔNLR1stFU > 0, on both a per-patient (HR = 2.7, p = 0.049) and per-tumor (HR = 2.8, p = 0.047) analysis. ΔNLR1stFU > 0 occurred in 24/42 patients (57.1%). In this subgroup, higher rates of female patients (p = 0.026), higher mean baseline NLR (p < 0.0001) and lower mean energy/size (p = 0.006) were observed. Upon ROC curve analysis, energy/size < 1414 J/mm predicted ΔNLR1stFU > 0 with 76% sensitivity and 70% specificity (AUC = 0.74).

Conclusion: NLR increase after ablation was the only independent predictor of LTP, supporting the role of balance between systemic inflammation and immunity in recurrence after MWA. Ablation energy/tumor size predicted NLR increase, reinforcing the concept of immune ablation.

Level of evidence: III.

Keywords: Adaptive immune response; Hepatocellular carcinoma; Inflammation; Microwave; NLR; Thermal ablation.

PubMed Disclaimer

References

    1. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391:1301–14.
    1. Grandhi MS, Kim AK, Ronnekleiv-Kelly SM, Kamel IR, Ghasebeh MA, Pawlik TM. Hepatocellular carcinoma: from diagnosis to treatment. Surg Oncol. 2016;25:74–85.
    1. Xu XL, Di LX, Liang M, Luo BM. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Radiology. 2018;287:461–72.
    1. Di Sandro S, Benuzzi L, Lauterio A, Botta F, De Carlis R, Najjar M, et al. Single hepatocellular carcinoma approached by curative-intent treatment: a propensity score analysis comparing radiofrequency ablation and liver resection. Eur J Surg Oncol. 2019;45(9):1691–9.
    1. Kim JS, Kim W, So YH, Yu SJ, Kim BG. Topographical impact of hepatitis B-related hepatocellular carcinoma on local recurrence after radiofrequency ablation. J Clin Gastroenterol. 2014;48:66–72.

LinkOut - more resources