title: Neutrophil to lymphocyte ratio predicts disease progression following intra-arterial therapy of hepatocellular carcinoma.
abstract: Prospectively predicting response to intra-arterial therapy for hepatocellular carcinoma (HCC) is challenging. Neutrophil/lymphocyte ratio (NLR) is a serum biomarker that is associated with survival for multiple malignancies. It was hypothesized that increased NLR would be associated with early disease progression after intra-arterial therapy of HCC.
  
  
  
  The outcomes of 86 treatment-naïve patients who had chemoembolization or radioembolization of HCC between July 2013-July 2014 were reviewed. Pre-treatment laboratory tests and imaging were used to measure NLR, Child-Pugh (CP) score, tumor number and tumor size. High/low NLR groups were defined as >3 and <3 respectively. Follow-up imaging at two months with assessed response using modified response criteria in solid tumors (mRECIST).
  
  
  
  NLR >3 was seen in 25/86 patients (range 3.0-21.6). NLR >3 patients had a significantly higher baseline CP score. Comorbidities were otherwise similar between groups as was tumor number/size. Disease control was significantly worse (p = 0.014) with NLR >3. Logistic regression for tumor response revealed NLR >3 as the best predictor of early progression (p < 0.0001).
  
  
  
  NLR may be a serologic biomarker of early progressive disease after intra-arterial therapy of HCC. Future research should focus on outcomes by treatment type or potentially combining arterial therapies with ablation and/or targeted biologic agents.
authors.affiliation: Vanderbilt University School of Medicine, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Taussig
authors.affiliation: Vanderbilt University School of Medicine, USA.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Irene Koran
authors.affiliation: Department of Radiology and Radiologic Sciences, USA.
authors.forename: Samdeep K
authors.initials: SK
authors.lastname: Mouli
authors.affiliation: Department of Radiology and Radiologic Sciences, USA.
authors.forename: Asma
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Surgery, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Geevarghese
authors.affiliation: Department of Radiology and Radiologic Sciences, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Baker
authors.affiliation: Department of Radiology and Radiologic Sciences, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lipnik
authors.affiliation: Department of Radiology and Radiologic Sciences, USA.
authors.forename: Fil
authors.initials: F
authors.lastname: Banovac
authors.affiliation: Department of Radiology and Radiologic Sciences, USA; Department of Biomedical Engineering, USA. Electronic address: daniel.b.brown@vanderbilt.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Brown
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000276:immunology* / Q000473:pathology / Q000628:therapy*; D016015:Logistic Models; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000276:immunology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000276:immunology*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals