title: Pre-treatment neutrophil-to-lymphocyte ratio affects survival in patients with advanced hepatocellular carcinoma treated with sorafenib.
abstract: Sorafenib is the first systemic therapy to demonstrate survival benefit in advanced hepatocellular carcinoma (HCC) in randomized controlled trials with rigorous patient selection. Neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor survival in various solid tumors. Our aim is to evaluate the prognostic role of NLR in HCC patients treated with sorafenib. A total of 105 advanced HCC patients treated with sorafenib were retrospectively reviewed, and relevant data from the clinical records were collected. Univariate and multivariate analysis were carried out to identify factors associated with survival. The median age of the cohort was 59.7 years, and 84.8 % were Child-Pugh class A, and 86.7 % had ECOG performance status 0 or 1. Median duration of sorafenib treatment was 100 days. Median overall survival (OS) of the entire cohort was 8.03 months. Median OS was 5.23 months (95 % CI 2.96-7.50 months) and 10.05 months (95 % IC 2.52-18.47 months) for patients with NLR > 3.5 and NLR ≤ 3.5, respectively (p = 0.002). Alpha-fetoprotein >1,030 ng/mL and serum albumin ≤3.8 g/dL were also associated with worse prognosis (p = 0.006 and p = 0.042, respectively). The subgroup of patients with high alpha-fetoprotein, low albumin and NLR > 3.5 had median OS of 1.7 months, whereas the subgroup with none of these parameters had median OS of 16.5 months (p < 0.001). NLR affects survival in advanced HCC patients treated with sorafenib. Selecting HCC patients based on the laboratorial features may improve the therapeutic effectiveness of sorafenib.
authors.affiliation: Cancer Institute of Sao Paulo State, University of Sao Paulo, Av. Dr. Arnaldo 251, São Paulo, São Paulo, Brazil, leogfonseca@hotmail.com.
authors.forename: Leonardo Gomes
authors.initials: LG
authors.lastname: da Fonseca
authors.forename: Romulado
authors.initials: R
authors.lastname: Barroso-Sousa
authors.forename: Afonso da Silva Alves
authors.initials: Ada S
authors.lastname: Bento
authors.forename: Bruna Paccola
authors.initials: BP
authors.lastname: Blanco
authors.forename: Gabriel Luis
authors.initials: GL
authors.lastname: Valente
authors.forename: Tulio Eduardo Flesch
authors.initials: TE
authors.lastname: Pfiffer
authors.forename: Paulo Marcelo
authors.initials: PM
authors.lastname: Hoff
authors.forename: Jorge
authors.initials: J
authors.lastname: Sabbaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D008214:Lymphocytes / Q000187:drug effects / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects / Q000378:metabolism*; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib