Dados do Trabalho

Título

EARLY VARIATION IN NEUTROPHIL-TO-LYMPHOCYTE RATIO IS ASSOCIATED WITH SURVIVAL IN HEPATOCELLULAR CARCINOMA UNDER SYSTEMIC TREATMENT.

Introdução

The search for biomarkers that anticipate treatment benefit in hepatocellular carcinoma (HCC) is challenging because there is a weak correlation between survival outcomes and radiological response to targeted therapies. Systemic inflammation is increasingly recognized as a determinant of survival in HCC and evolutionary changes in biomarkers of inflammation can be a tool to support practical decisions.

Objetivo

In this study, we aimed to evaluate the prognostic impact of longitudinal changes in neutrophil-to-lymphocyte ratio (NLR) within the first month of sorafenib therapy in patients with HCC.

Método

HCC patients who received sorafenib from Jan/2017 and Nov/2019 were retrospectively evaluated. Subgroups were defined as NLR “low” or “high” according to the median value of NLR in the cohort (3.4). Baseline and 1-month laboratorial parameters were registered. Overall survival (OS) was estimated by Kaplan-Meier method, compared using log-rank and adjusted with a Cox regression model.

Resultado

125 patients were included: 69.2% male, 92.8% Child-Pugh A, 62.3% HCV etiology, 81.6% BCLC stage C and 50.4% received previous locoregional therapies. In the time of the analysis, 80 patients had died. Median sorafenib duration was 6.5 months (IQR: 4.7-8.4) and median OS was 8.2 (95%CI 6.5-10.1). High NLR was associated with worse OS compared to low NLR at baseline (8.7 months [95%CI 5.9-10.9] vs 4.2 months [95%CI 2.1-7.0]; HR 2.2; CI95% 1.3-3.8; p=0.006). Similarly, high NLR at 1 month was associated with poorer OS (HR 2.3; CI95% 1.4-4.0; p=0.003). The median OS of patients who had NLR low both in baseline and at 1 month (“low-low”) was 10.1 months (95%CI 7.9-18.3), “high-low” was 8.8 months (95%CI 2.4-9.7), “low-high” was 5.1 months (95%CI 2.9-7.6) and “high-high” was 3.7 (95%CI 2.1-6.8), with a significant difference in prognosis between these subgroups (HR 1.5; 95%CI 1.2-1.9; p<0.0001).

Conclusão

Our study validates the prognostic role of NLR. Furthermore, we observed that the evolutionary variation of this biomarker may serve as an early predictor of survival in HCC patients under systemic therapy. Future research on the dynamics of inflammatory parameters may overcome limitations in assessing treatment response in HCC.

Palavras-chave

hepatocellular carcinoma, sorafenib, neutrophil-to-lymphocyte ratio

Área

Oncologia - Tumores TGI Superior (estômago, esôfago, pâncreas, fígado, vias biliares, duodeno)