title: Inflammatory markers are associated with outcome in patients with unresectable hepatocellular carcinoma undergoing transarterial chemoembolization.
abstract: BACKGROUND
  The serum neutrophil-lymphocyte ratio (NLR) is associated with outcomes in several solid organ cancers, including hepatocellular carcinoma (HCC).
  
  
  METHODS
  We reviewed our experience in patients with HCC who underwent transarterial chemoembolization (TACE) as the initial treatment. Serum complete blood counts were used to calculate the NLR before and after TACE. The Kaplan-Meier method was used to determine survival and significant differences between groups by the log-rank test.
  
  
  RESULTS
  There were 103 patients identified who underwent TACE for HCC. The median age was 60.5 years. Median overall survival was 12.6 (95% confidence interval 8.3-17) months. Median survival in patients with a high preprocedural NLR was 4.2 months compared to 15 months in those with a normal NLR (p = 0.021). In those whose NLR either rose 1 month after treatment or remained elevated, survival was worse compared to those who normalized or remained normal (18.6 vs. 10.6 months, p = 0.026). The same was true at 6 months (21.3 vs. 9.5 months, p = 0.002). An unresponsive NLR was associated with very poor outcome (median survival 3.7 months). Multivariate analysis of clinicopathologic factors showed that presence of extrahepatic disease and high NLR were independent factors associated with worse survival.
  
  
  CONCLUSIONS
  Our study demonstrates that periprocedural trends of serum NLR are associated with outcome in unresectable HCC undergoing TACE. Serum NLR is easy to calculate from a routine complete blood count with differential. Along with liver function, serum NLR may be helpful to clinicians in providing prognostic information and monitoring response to therapy.
authors.affiliation: Department of Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: McNally
authors.forename: Antonio
authors.initials: A
authors.lastname: Martinez
authors.forename: Hooman
authors.initials: H
authors.lastname: Khabiri
authors.forename: Gregory
authors.initials: G
authors.lastname: Guy
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: James
authors.initials: J
authors.lastname: Hanje
authors.forename: Robert
authors.initials: R
authors.lastname: Kirkpatrick
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D015415:Biomarkers