Prognostic ability of inflammation-based markers in radioembolization for hepatocellular carcinoma

Prognostic factors influencing outcomes in hepatocellular carcinoma patients undergoing selective internal radiation therapy

Selective internal radiation therapy (SIRT) has emerged as a viable endovascular treatment strategy for hepatocellular carcinoma (HCC). According to the Barcelona Clinic Liver Cancer (BCLC) classification, SIRT is currently recommended for early- and intermediate-stage HCC that is unsuitable for alternative locoregional therapies. Additionally, SIRT remains a recommended treatment for patients with advanced-stage HCC and portal vein thrombosis (PVT) without extrahepatic metastasis. Several studies have shown that SIRT is a versatile and promising treatment with a wide range of applications. Consequently, given its favourable characteristics in various scenarios, SIRT could be an encouraging treatment option for patients with HCC across different BCLC stages. Over the past decade, an increasing number of studies have focused on better understanding the prognostic factors associated with SIRT to identify patients who derive the most benefit from this treatment or to refine the optimal technical procedures of SIRT. Several variables can influence treatment decisions, with a growing emphasis on a personalised approach. This review, based on the literature, will focus on the prognostic factors associated with the effectiveness of radioembolization and related complications. By comprehensively analysing these factors, we aimed to provide a clearer understanding of how to optimise the use of SIRT in managing HCC patients, thereby enhancing outcomes across various clinical scenarios.

Combination of neutrophil/lymphocyte ratio and albumin/bilirubin grade as a prognostic predictor for hepatocellular carcinoma patients undergoing curative hepatectomy

BACKGROUND AND AIM

Prognosis determination is essential for hepatocellular carcinoma (HCC) patient management and treatment planning. The current study aimed to evaluate the prognosis performance of NLR, ALBI, and the combination of NLR-ALBI in determining the overall survival (OS) of HCC patients under curative hepatectomy.

METHODS

144 primary HCC patients with curative hepatectomy were recruited in the retrospective study. The clinicopathologic characteristics and OS were compared between stratified groups. The predictive performance of NLR, ALBI, and the combination of NLR-ALBI was explored by the area under the receiver operating characteristic curve (AUC). Univariate and multivariate analyses were used to determine the risk factors of OS.

RESULTS

AUC determined NLR cutoff > 2.60 for predicting prognosis. The univariate analysis indicated pathological differentiation, tumor size, AFP, TNM stage, NLR score, and ALBI grade were significant indicators of OS. However, only TMN grade, AFP, NLR score, and NLR-ALBI score were identified as independent predictors of OS in the multivariable analysis. The AUC of NLR, ALBI and the combination of NLR-ALBI was 0.618(95%CI 0.56-0.710), 0.533 (95%CI 0.437-0.629), 0.679 (95%CI 0.592-0.767) respectively. Patients with higher NLR-ALBI scores presented worse outcomes than those with lower NLR-ALBI scores.

CONCLUSION

NLR is an independent prognostic factor of HCC and a reliable biomarker in predicting the OS of HCC patients. The combination of NLR-ALBI showed a better prognostic performance than using NLR or ALBI alone, implicating the effectiveness and feasibility of combining multiple risk factors for postoperative prognosis assessment.

Inflammatory Scores: Correlation with Clinical Outcomes in Hepatocellular Carcinoma Patients Undergoing Transarterial Radioembolization

PURPOSE

To evaluate the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI) and systemic-inflammation index (SII) to predict clinical outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial radioembolization (TARE).

MATERIALS AND METHODS

One hundred forty-five patients who underwent treatment of 167 HCCs had their pretreatment and 1 month post treatment laboratory values evaluated. Overall survival (OS), progression-free survival (PFS) and local PFS models were performed with patients separated by median inflammatory scores.

RESULTS

The median pretreatment NLR, PLR, ALRI and SII were 3.0 (range: 0.5-176), 104.4 (range: 25-830), 55.7 (range: 7.5-2090) and 360.2 (range: 51.1-7207.8), respectively. While the median post treatment NLR, PLR, ALRI and SII were 6.2 (range: 0.4-176), 180 (range: 35-2100), 125 (range: 15.9-5710) and 596.8 (range: 28.9-19,320), respectively. OS models showed significant differences when separating the groups by median post treatment NLR (p = 0.003) and SII (p = 0.003). Multivariate Cox regression models for OS with all pre and post treatment inflammatory markers (log-scale) as well as tumor size, AFP and Child-Pugh score showed significant pretreatment NLR [HR: 0.22 (95% CI:0.06-0.75), p = 0.016] and SII [3.52 (95% CI: 1.01-12.3), p = 0.048], as well as post treatment NLR [6.54 (95% CI: 1.57-27.2), p = 0.010] and SII [0.20 (95% CI: 0.05-0.82), p = 0.025] association. The post treatment ALRI (p = 0.010) correlated with PFS while, post treatment NLR (p < 0.001), ALRI (p = 0.024) and SII (p = 0.005) correlated with local PFS.

CONCLUSION

Pretreatment and post treatment NLR and SII may be associated with OS and post treatment ALRI may be associated with both PFS and local PFS in HCC patients undergoing TARE.

Development and Validation of a Nomogram for the Estimation of Response to Platinum-Based Neoadjuvant Chemotherapy in Patients with Locally Advanced Cervical Cancer

Purpose

Non-response to platinum-based neoadjuvant chemotherapy (non-rNACT) reduces the surgical outcomes of patients with locally advanced cervical cancer (LACC). The development of an accurate preoperative method to predict a patient’s response to NACT (rNACT) could help surgeons to manage therapeutic intervention in a more appropriate manner.

Patients and Methods

We recruited a total of 341 consecutive patients who underwent platinum-based NACT followed by radical surgery (RS) at the Hubei Cancer Hospital between January 1, 2010 and April 1, 2020. All patients had been diagnosed with stage Ib2-IIa2 cervical cancer in accordance with the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification system. First, we created a training cohort of patients who underwent NACT+RS (n=239) to develop a nomogram. We then validated the performance of the nomogram in a validation cohort of patients who underwent NACT+RS (n=102). Data analysis was conducted from October 1, 2020. First, we determined overall survival (OS) and progression-free survival (PFS) after NACT+RS. Multivariate logistic regression was then used to identify independent risk factors that were associated with the response to rNACT; these were then incorporated into the nomogram.

Results

The analysis identified several significant differences between the rNACT and non-rNACT groups, including neutrophil–lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), lymphocyte monocyte ratio (LMR), platelet count, and FIGO stage. The performance of the rNACT nomogram score exhibited a robust C-index of 0.76 (95% confidence interval [CI]: 0.65 to 0.87) in the training cohort and high C-index of 0.71 (95% CI: 0.62 to 0.78) in the validation cohort. Clinical impact curves showed that the nomogram had good predictive ability.

Conclusion

We successfully established an accurate and optimized nomogram that could be used preoperatively to predict rNACT in patients with LACC. This model can be used to evaluate the risk of an individual patient experiencing rNACT and therefore facilitate the choice of treatment.