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European Radiology
Published in: European Radiology 10/2020

01-10-2020 | Hepatocellular Carcinoma | Interventional

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE

Authors: Isabel Theresa Schobert, Lynn Jeanette Savic, Julius Chapiro, Khaled Bousabarah, Evan Chen, Fabian Laage-Gaupp, Jonathan Tefera, Nariman Nezami, MingDe Lin, Jeffrey Pollak, Todd Schlachter

Published in: European Radiology | Issue 10/2020

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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 work-up prior to treatment included complete and differential blood count, liver function, and alpha-fetoprotein levels. Neutrophil-to-lymphocyte 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 non-spherical 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-to-lymphocyte 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.
Appendix
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Metadata
Title
Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of tumor response in hepatocellular carcinoma after DEB-TACE
Authors
Isabel Theresa Schobert
Lynn Jeanette Savic
Julius Chapiro
Khaled Bousabarah
Evan Chen
Fabian Laage-Gaupp
Jonathan Tefera
Nariman Nezami
MingDe Lin
Jeffrey Pollak
Todd Schlachter
Publication date
01-10-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 10/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06931-5

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