title: The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients with Unresectable Hepatocellular Carcinoma Treated with Radioembolization.
abstract: OBJECTIVE
  To assess the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with unresectable intermediate- or advanced-stage hepatocellular carcinoma (HCC) treated with yttrium-90 radioembolization (RE).
  
  
  METHODS
  Retrospective chart review was performed for 176 patients with intermediate- or advanced-stage HCC treated with RE between August 2000 and November 2012. The appropriate NLR cutoff was determined by receiver operating characteristic curves. Demographic, clinical, radiographic, and pathologic parameters were compared between patients with a normal NLR (< 5) and those with an elevated NLR (≥ 5) before RE. Barcelona Clinic Liver Cancer (BCLC) stage-stratified univariate and multivariate analyses were conducted to determine variables associated with overall survival.
  
  
  RESULTS
  Under univariate analyses, patients with a normal NLR were found to have longer survival than individuals with a high NLR in intermediate/advanced-disease and advanced-disease cohorts. A multivariate Cox proportional-hazards model in the advanced-disease group confirmed that elevated NLR, high α-fetoprotein level, and low albumin level were independent predictors of worse survival.
  
  
  CONCLUSIONS
  This study provides stage-dependent evidence for the prognostic role of NLR in the radioembolized HCC cohort. Patients with BCLC stage C disease with elevated NLR may not derive benefit from RE, and other intervening modalities should be explored in this subpopulation.
authors.affiliation: Departments of Surgery.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Sukato
authors.affiliation: Departments of Surgery.
authors.forename: Samer
authors.initials: S
authors.lastname: Tohme
authors.affiliation: Epidemiology.
authors.forename: Didier
authors.initials: D
authors.lastname: Chalhoub
authors.affiliation: Departments of Surgery.
authors.forename: Katrina
authors.initials: K
authors.lastname: Han
authors.affiliation: Radiology, University of Pittsburgh School of Medicine, 3471 Fifth Ave., Suite 300, Pittsburgh, PA 15213.
authors.forename: Albert
authors.initials: A
authors.lastname: Zajko
authors.affiliation: Radiology, University of Pittsburgh School of Medicine, 3471 Fifth Ave., Suite 300, Pittsburgh, PA 15213.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Amesur
authors.affiliation: Radiology, University of Pittsburgh School of Medicine, 3471 Fifth Ave., Suite 300, Pittsburgh, PA 15213.
authors.forename: Philip
authors.initials: P
authors.lastname: Orons
authors.affiliation: Departments of Surgery.
authors.forename: James W
authors.initials: JW
authors.lastname: Marsh
authors.affiliation: Departments of Surgery.
authors.forename: David A
authors.initials: DA
authors.lastname: Geller
authors.affiliation: Departments of Surgery. Electronic address: tsunga@upmc.edu.
authors.forename: Allan
authors.initials: A
authors.lastname: Tsung
mesh_terms: D000368:Aged; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009504:Neutrophils; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes