Prognostic ability of inflammation-based markers in radioembolization for hepatocellular carcinoma

Aim:Inflammation-based markers,such as the neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have recently been used as prognostic indicators in hepatocellular carcinoma(HCC).We aimed to determine whether NLR and PLR may predict response to yttrium-90 transarterial radioembolization(TARE)as primary treatment for HCC.Methods:We performed a retrospective review of a prospectively collected database of HCC cases(1994-2019)and selected patients who received TARE as primary treatment(n=42).Laboratory studies were used to calculate NLR and PLR.Response to TARE was determined using the modified response evaluation criteria in solid tumors(mRECIST).Patients were classified as non-responders(stable or progressive disease)or responders(partial or complete response)to treatment based on mRECIST.Results:Receiver operating characteristic curves identified a pre-treatment NLR cutoff of≥2.83 and a pre-treatment PLR cutoff of≥83 for predicting non-response to treatment.Pre-treatment NLR≥2.83 was the only significant predictor of non-response to TARE in multivariate logistic regression analysis(odds ratio 7.83,P=0.036).On time to progression analysis,both pre-treatment NLR≥2.83 and pre-treatment PLR≥83 were associated with a higher proportion of tumor progression at 6 months post-treatment(43.6%vs.10.0%,P=0.014,log-rank)and(38.6%vs.0%,P=0.010,log-rank),respectively.Conclusion:NLR confers prognostic value and may be superior to PLR in determining response to TARE as primary treatment for HCC.Future studies are necessary to validate these findings in a larger cohort.