title: Combination of neutrophil-to-lymphocyte ratio and early des-γ-carboxyprothrombin change ratio as a useful predictor of treatment response for hepatic arterial infusion chemotherapy against advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatic arterial infusion chemotherapy (HAIC) is a potent therapeutic option for advanced hepatocellular carcinoma (HCC). However, there are few known predictive factors of treatment response to HAIC. We clarified the most accurate predictive factors early on in treatment.
  
  
  METHODS
  Study subjects were 70 patients with advanced HCC who had been treated with HAIC. We assessed the relationships between patient characteristics, change ratios of early tumor markers, tumor response, progression-free survival (PFS), and overall survival.
  
  
  RESULTS
  After two courses of HAIC, 1 (1.4%), 16 (22.9%), 30 (42.8%), and 23 (32.9%) of the 70 patients showed complete response, partial response, stable disease, and progressive disease, respectively. Overall survival was related to Child-Turcotte-Pugh score, extrahepatic metastasis, and the des-γ-carboxyprothrombin (DCP) response. Univariate and multivariate analyses identified the neutrophil-to-lymphocyte ratio (NLR) and DCP response as significant determinants of treatment response and PFS. Progression-free survival with a low NLR (<2.87) was significantly longer than with a high NLR (median, 8.4 months vs. 2.8 months, respectively). Progression-free survival was 7.2 months for patients with a responsive DCP (<0.7) and 2.3 months for an unresponsive DCP (≥0.7). Additionally, even with baseline high NLR, patients with responsive DCP achieved better PFS.
  
  
  CONCLUSIONS
  Baseline NLR and early DCP response were significant predictors of treatment response and PFS after HAIC for patients with advanced HCC. The combination of baseline NLR and early DCP response could be accurate and useful predictive factors of response to HAIC and could help optimize treatments for patients with advanced HCC.
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Tsunematsu
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Goki
authors.initials: G
authors.lastname: Suda
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Yamasaki
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Takaaki
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Machiko
authors.initials: M
authors.lastname: Umemura
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Ito
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Fumiyuki
authors.initials: F
authors.lastname: Sato
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nakai
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Sho
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Morikawa
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Gastroenterological Surgery 1, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.affiliation: Gastroenterological Surgery 1, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.affiliation: Departments of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
keywords: advanced hepatocellular carcinoma; des-γ-carboxyprothrombin and neutrophil-to-lymphocyte ratio; hepatic arterial infusion chemotherapy