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Friday, January 24, 2020

Neutrophil/Lymphocyte Ratio Predicts Increased Risk of Immediate Progressive Disease following Chemoembolization of Hepatocellular Carcinoma

Clinical question

Do patients with hepatocellular carcinoma (HCC) and elevated neutrophil/lymphocyte ratio (NLR) have a greater risk of progressive disease following initial transarterial chemoembolization (TACE)?

Take-away point
Elevated baseline NLR is associated with higher rates of HCC tumor progression at 2-month follow-up imaging after TACE.

Cruz, J et al. Neutrophil/Lymphocyte Ratio Predicts Increased Risk of Immediate Progressive Disease following Chemoembolization of Hepatocellular Carcinoma. Journal of Vascular and Interventional Radiology, Volume 30, Issue 12, 1887 – 1892.

Click here for abstract

Study design
Retrospective review

Funding source
Self-funded or unfunded

Single institution


As an indicator of inflammation, serum neutrophil to lymphocyte ratio (NLR) is being increasingly utilized as a prognostic marker for a variety of disease states. As the survival for locoregional therapies for HCC varies widely, the authors of this study looked at NLR to determine a potential association with disease progression after TACE.

The authors reviewed 190 patients who underwent 254 TACE procedures. TACE was performed with both lipiodol-based conventional technique and drug-eluting embolics (DEB) and followed with CT or MRI 2 months following treatment to assess response using mRECIST. Treatment outcomes did not differ between conventional TACE and DEB-TACE. Thirty-nine patients developed progressive disease at the 2 month follow up imaging study. Mean NLR for this group was 4.1, compared to 2.76 or less for patients with complete response, partial response, or stable disease. Regression analysis showed that NLR and the presence of more than 1 tumor were predictive of mRECIST progression whereas age, liver function, tumor size, and cause of cirrhosis did not predict response (or progression). If one were to use NLR of 3.5 as a cutoff, objective response was achieved in 74% of treatments with NLR <3.5, compared with 52% with a higher NLR. Disease control was also significantly higher in patients with an NLR <3.5 (87% vs 76%; P = .002 by chi-squared analysis).


In the era of personalized medicine, this study provides prognostic information for our oncology patients and allows us to better determine which patients might respond best to our therapies. NLR is being actively investigated for its prognostic impact and role in a variety of conditions, including colorectal and prostate cancer, patients undergoing transcatheter aortic valve replacement, atrial fibrillation, and even psychosis (1-5). As such, it is no surprise that an inflammatory environment has implications for our treatments. This study showed that elevated baseline NLR is associated with higher rates of HCC progression at 2 month follow-up after TACE. The authors acknowledge that the relationship between NLR and tumor multiplicity, tumor markers, and Child-Pugh score still needs to be further elucidated. However, this work is a good early step in understanding the role NLR plays in HCC patients.

Zagum Bhatti, MD
Assistant Professor
Department of Radiology, Interventional Radiology Division
University of Texas Health Science Center at Houston, Houston, TX

1 comment:

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