Dynamic Changes in the Neutrophil-to-Lymphocyte Ratio Predict the Prognosis of Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization
Dynamic Changes in the Neutrophil-to-Lymphocyte Ratio Predict the Prognosis of Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization
复制标题
中性粒细胞与淋巴细胞比率的动态变化可预测接受肝动脉化疗栓塞的肝细胞癌患者的预后
DOI：
10.2147/cmar.s245396
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发表时间：
2020-01-01
影响因子：
3.3
通讯作者：
Li, Jiaping
中科院分区：
文献类型：
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作者：
Wang, Hongyu;Lin, Chuyang;Li, Jiaping
目的探讨肝细胞癌（HCC）患者经动脉化疗栓塞术（TACE）后外周血嗜中性粒细胞/淋巴细胞比值（NLR）的动态变化对肿瘤疗效和总生存期（OS）的影响。方法回顾性分析181例原发性肝癌患者的临床资料。在TACE前1-3天、TACE后3-6周和3个月获得白色血细胞、中性粒细胞和淋巴细胞计数以及NLR。根据NLR的平均值将患者分为两组，并根据NLR的动态变化将患者分为持续下降组、波动性升高-下降（I-D）组、波动性降低-升高（D-I）组和持续性升高组。采用重复测量方差分析法分析血细胞计数和NLR的动态变化。使用多变量logistic回归模型检查不同NLR组中肿瘤缓解的比值比（OR）。最后，使用考克斯回归模型检查NLR动态变化的预后价值。结果TACE治疗后3-6周及3个月，白色细胞计数、中性粒细胞计数及淋巴细胞计数持续下降。应答者的NLR略有增加，然后大幅下降，而无应答者的NLR略有增加，然后显著下降，时间×肿瘤应答存在显著的交互作用（P = 0.005）。TACE前、TACE后3-6周和3个月NLR分组与肿瘤缓解无关，仅TACE后3个月NLR分组与肿瘤缓解相关，在单变量生存分析中显示出显著差异（NLR > 2.5 vs NLR ≤ 2.5，风险比[HR] = 2.442，95%置信区间（CI）：1.545，3.860）。NLR的变化与肿瘤缓解和OS显著相关。TACE无应答者在NLR持续增加组（OR = 6.230，95% CI：1.848-21.001）和D-I波动组（OR = 5.702，95% CI：1.480-21.957）中更常见。多变量分析显示，这两个患者组的OS也较差（分别为HR = 2.351，95% CI：1.120-4.605和HR = 2.320，95% CI：1.187-4.533）。结论NLR动态变化可能比静态NLR值更能预测肿瘤缓解和OS，但需要更多的数据。
Purpose To examine the effect of dynamic changes in neutrophil-to-lymphocyte ratio (NLR) on tumor response and overall survival (OS) in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Patients and Methods Data from 181 patients with HCC were retrospectively collected. White blood cell, neutrophil and lymphocyte counts, and the NLR were obtained 1–3 days before as well as 3–6 weeks and 3 months after TACE. Patients were divided into two groups at each time point according to the mean value of NLR, and also divided into continuous decrease, fluctuating increase-decrease (I-D), fluctuating decrease-increase (D-I), and continuous increase groups according to the dynamic changes in the NLR. The dynamic changes in blood counts and NLR were analyzed using repeated-measures ANOVA. The odds ratios (ORs) for tumor response in different NLR groups were examined using a multivariate logistic regression model. Finally, the prognostic value of the dynamic changes in the NLR was examined using Cox regression models. Results Continuous decline of white blood cell counts, neutrophil counts and lymphocyte counts were observed at 3–6 weeks and 3 months after TACE treatment. The NLR increased slightly and then decreased substantially in responders, while it increased slightly and then significantly in non-responders, with a significant interaction effect of Time × Tumor response (P = 0.005). NLR grouping before TACE, 3–6 weeks and 3 months after TACE was not associated with tumor response, and only 3 months after TACE did, it shows a significant difference in univariate survival analyses (NLR > 2.5 vs NLR ≤ 2.5, hazard ratio [HR] = 2.442, 95% confidence interval (CI): 1.545, 3.860). The changes in the NLR were significantly correlated with tumor response and OS. Non-responders for TACE were more common in the continuous NLR increase group (OR = 6.230, 95% CI: 1.848–21.001) and in the fluctuating D-I group (OR = 5.702, 95% CI: 1.480–21.957). Multivariate analyses revealed that these two patient groups also showed poorer OS (HR = 2.351, 95% CI: 1.120–4.605 and HR = 2.320, 95% CI: 1.187–4.533, respectively). Conclusion Dynamic changes in the NLR may be better predictors of tumor response and OS than static NLR values, but more data are needed.