title: Blood neutrophil to lymphocyte ratio as a predictor in patients with advanced hepatocellular carcinoma treated with hepatic arterial infusion chemotherapy.
abstract: OBJECTIVE
  Inflammation plays a critical role in cancer. The aim of the present study was to investigate the impact of neutrophil to lymphocyte ratio (NLR) on patients with advanced hepatocellular carcinoma (HCC) treated with hepatic arterial infusion chemotherapy (HAIC).
  
  
  METHODS
  We retrospectively evaluated 266 patients with advanced HCC treated with HAIC between March 2003 and December 2012. NLR was calculated from the differential leukocyte count by dividing the absolute neutrophil count by the absolute lymphocyte count.
  
  
  RESULTS
  The cut-off level of NLR was set as the median value of 2.87 among all patients in this study. The objective response rate in the patients with low NLR was 37.6%, which was significantly better than that of the patients with high NLR (21.1%; P < 0.01). Multivariate analysis revealed that low NLR remained associated with the response to HAIC (P = 0.024). Median progression-free survival and median overall survival in patients with high NLR were 3.2 and 8.0 months, respectively, which were significantly shorter than that of the patients with low NLR (5.6 and 20.7 months; P < 0.01 and P < 0.01, respectively). High NLR was an independent unfavorable prognostic factor in multivariate analysis. The patient outcome was stratified more clearly by NLR calculated after HAIC added to calculations before HAIC. Serum platelet-derived growth factor-BB level was positively correlated with NLR.
  
  
  CONCLUSIONS
  Results suggest that NLR is a useful predictor in patients with advanced HCC treated with HAIC. These findings may be useful in determining treatment strategies or in designing clinical chemotherapy trials in future.
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Terashima
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Noriho
authors.initials: N
authors.lastname: Iida
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Arai
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kitamura
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kagaya
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Eishiro
authors.initials: E
authors.lastname: Mizukoshi
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Honda
authors.affiliation: Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
keywords: hepatic arterial infusion chemotherapy; hepatocellular carcinoma; neutrophil lymphocyte ratio; predictive factor; prognostic factor