Neutrophil-to-lymphocyte Ratio (NLR) as an Index of Response to Treatment in Patients with Hepatocellular Carcinoma after Receiving Trans-arterial Chemoembolization (TACE)

BackgroundTrans-arterial chemoembolization (TACE) is commonly used for patients with large, un-resectable tumors or bridge therapy in patients with hepatocellular carcinoma (HCC) prior to liver transplantation. We evaluated the response to TACE treatment in patients with hepatocellular carcinoma according to modified RECIST criteria and determined the prognostic value of neutrophil-to-lymphocyte ratio (NLR). MethodsPatients with definitive diagnosis of HCC referred for TACE were studied. The response rate to TACE treatment was assessed based on dynamic MRI 28-days after treatment according to modified RECIST. The NLR value was calculated and its prognostic value was evaluated to predict the response to treatment. ResultsForty patients with HCC who underwent TACE were included in the study. The response to TACE treatment in included patients was: complete response (CR) in 6 patients (15%), partial response (PR) in 16 patients (40%) and stable disease (SD) in 18 patients (45%). No progressive disease (PD) was found. Responders (CR+PR) were 22 (55%) cases. The mean NLR after treatment in the non-responder group was significantly higher than the responder group (4.2 vs 2.4, P-value=0.026). NLR values greater than 2.6 after treatment had a sensitivity of 70.6% and a specificity of 77.3% in the diagnosis of non-responders with an Area Under the Curve of 0.73 [95% confidence interval 0.58-0.89], P-value=0.011). ConclusionCompared to responders, higher levels of NLR after treatment were observed in the non-responder group. NLR level more than 2.6 after treatment is believed to be able to discriminate non-responders as a moderate prognostication tool.