title: Imbalance in systemic inflammation and immune response following transarterial chemoembolization potentially increases metastatic risk in huge hepatocellular carcinoma.
abstract: Inflammation plays a critical role in tumor metastasis. However, few inflammation-related biomarkers are currently available to predict the risk of metastasis for advanced hepatocellular carcinoma (HCC). Using huge tumors (diameter >10 cm) as a model, we evaluated the potential risk of pre- and post-treatment inflammatory responses in the development of metastasis of HCC patients undergoing transarterial chemoembolization (TACE). A logistic regression model was used to analyze the risk factors. One hundred and sixty-five patients with huge HCC were enrolled in the study. Metastases were identified in 25.5% (42/165) patients by imaging evaluation post-TACE. Neutrophils increased, whereas lymphocytes decreased significantly post-TACE. Univariate analysis showed that high post-treatment neutrophil-to-lymphocyte ratio (NLR; p = 0.003), low post-treatment lymphocyte count (p = 0.047), and high baseline NLR (p = 0.100) were potential risk factors for metastasis. Further, multivariate analysis showed that high post-treatment NLR, but not pre-treatment NLR, was an independent risk factor for metastasis; this was confirmed by receiver operating characteristic curve analysis. Post-treatment NLR, however, had no correlation to tumor response and overall survival of patients. In conclusion, post-treatment NLR but not pre-treatment NLR independently increases the risk of metastasis in huge HCC. Our findings suggest the potential contribution of treatment-related inflammation to metastasis in advanced HCC.
authors.affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, People's Republic of China.
authors.forename: Tong-Chun
authors.initials: TC
authors.lastname: Xue
authors.affiliation: Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China.
authors.forename: Qing-An
authors.initials: QA
authors.lastname: Jia
authors.affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, People's Republic of China.
authors.forename: Ning-Ling
authors.initials: NL
authors.lastname: Ge
authors.affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.|Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, People's Republic of China.|Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
authors.forename: Bo-Heng
authors.initials: BH
authors.lastname: Zhang
authors.affiliation: Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China. slye@shmu.edu.cn.|Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, People's Republic of China. slye@shmu.edu.cn.
authors.forename: Sheng-Long
authors.initials: SL
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007113:Immunity, Innate; D007249:Inflammation / Q000150:complications / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009504:Neutrophils / Q000473:pathology; D012307:Risk Factors
keywords: Chemoembolization; Hepatocellular carcinoma; Immune; Inflammation; Metastasis