Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma a
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INTERVENTIONAL
Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE Isabel Theresa Schobert 1,2 & Lynn Jeanette Savic 1,2 & Julius Chapiro 1 & Khaled Bousabarah 1,3 & Evan Chen 1 & Fabian Laage-Gaupp 1 & Jonathan Tefera 1,2 & Nariman Nezami 1 & MingDe Lin 1 & Jeffrey Pollak 1 & Todd Schlachter 1 Received: 2 January 2020 / Revised: 15 March 2020 / Accepted: 30 April 2020 # European Society of Radiology 2020
Abstract Objectives To investigate the predictive value of quantifiable imaging and inflammatory biomarkers in patients with hepatocellular carcinoma (HCC) for the clinical outcome after drug-eluting bead transarterial chemoembolization (DEB-TACE) measured as volumetric tumor response and progression-free survival (PFS). Methods This retrospective study included 46 patients with treatment-naïve HCC who received DEB-TACE. Laboratory workup prior to treatment included complete and differential blood count, liver function, and alpha-fetoprotein levels. Neutrophil-tolymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were correlated with radiomic features extracted from pretreatment contrast-enhanced magnetic resonance imaging (MRI) and with tumor response according to quantitative European Association for the Study of the Liver (qEASL) criteria and progression-free survival (PFS) after DEB-TACE. Radiomic features included single nodular tumor growth measured as sphericity, dynamic contrast uptake behavior, arterial hyperenhancement, and homogeneity of contrast uptake. Statistics included univariate and multivariate linear regression, Cox regression, and Kaplan– Meier analysis. Results Accounting for laboratory and clinical parameters, high baseline NLR and PLR were predictive of poorer tumor response (p = 0.014 and p = 0.004) and shorter PFS (p = 0.002 and p < 0.001). When compared to baseline imaging, high NLR and PLR correlated with non-spherical tumor growth (p = 0.001 and p < 0.001). Conclusions This study establishes the prognostic value of quantitative inflammatory biomarkers associated with aggressive nonspherical tumor growth and predictive of poorer tumor response and shorter PFS after DEB-TACE. Key Points • In treatment-naïve hepatocellular carcinoma (HCC), high baseline platelet-to-lymphocyte ratio (PLR) and neutrophil-tolymphocyte ratio (NLR) are associated with non-nodular tumor growth measured as low tumor sphericity. • High PLR and NLR are predictive of poorer volumetric enhancement-based tumor response and PFS after DEB-TACE in HCC. • This set of readily available, quantitative immunologic biomarkers can easily be implemented in clinical guidelines providing a paradigm to guide and monitor the personalized application of loco-regional therapies in HCC. Keywords Hepatocellular carcinoma . Platelet count . Neutrophils . Lymphocytes . Radiomics
Isabel Schobert and Lynn Jeanette Savic contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s
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