The prognostic and predictive value of the combination of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma who receive transarterial chemoembolization therapy

Figures & data

Table 1 Relationship between clinic and radiological factors and NLR–PLR score

Characteristic	Parameter	N	NLR–PLR score			P-value
			1	2	3
Total		216	34	56	126
Age (years)	<60	158	26	40	92	0.871
	≥60	58	8	16	34
Gender	Males	200	31	53	116	0.781
	Females	16	3	3	10
WBC (×10^9/L)	<10	215	34	56	125	0.699
	≥10	1	0	0	1
CRP (mg/L)	<8	112	27	38	47	<0.001
	≥8	104	7	18	79
ALT (U/L)	<40	83	12	21	50	0.885
	≥40	133	22	35	76
AST (U/L)	<45	64	11	23	30	0.058
	≥45	152	23	33	96
ALB (g/L)	<35	28	4	7	17	0.958
	≥35	188	30	49	109
TBIL (mmol/L)	<20.5	169	25	43	101	0.675
	≥20.5	47	9	13	25
ALP (U/L)	<100	65	12	24	29	0.021
	≥100	151	22	32	97
GGT (U/L)	<50	24	6	8	10	0.189
	≥50	192	28	48	116
AFP (ng/mL)	<400	116	20	34	62	0.288
	≥400	100	14	22	64
HBV-DNA (IU/mL)	<100	54	8	13	33	0.892
	≥100	162	26	43	93
Tumor diameter (cm)	<5	39	12	16	11	<0.001
	≥5	177	22	40	115
Tumor number	Single	39	2	9	28	0.081
	Multiple	177	32	47	98
Vascular invasion	Absent	133	25	37	71	0.136
	Present	83	9	19	55
HBV infection	Absent	6	0	3	3	0.298
	Present	210	34	53	123
Child-Pugh classification	A	168	30	45	93	0.172
	B	48	4	11	33
Performance status	0–1	193	33	50	110	0.536
	2	23	1	6	16
BCLC stage	B	36	6	12	18	0.484
	C	180	28	44	108
CLIP score	1	56	10	13	33	0.203
	2	60	12	11	37
	3	75	11	26	38
	4	25	1	6	18

Abbreviations: AFP, α-fetoprotein; ALB, albumin; ALT, alanine transaminase; AST, aspartate aminotransferase; BCLC, Barcelona Clinic Liver Cancer; CLIP, Cancer of the Liver Italian Program; CRP, C-reactive protein; GGT, gamma-glutamyl transpeptidase; HBV-DNA, hepatitis B virus DNA; NLR–PLR, neutrophil/platelet-to-lymphocyte ratio; TBIL, total bilirubin; WBC, white blood cell count.

Table 2 Correlations of inflammation parameters for HCC patients after TACE therapy

Characteristic		NLR	PLR	NLR–PLR	PI	mGPS	PNI	CRP
NLR	r	1.000	0.394	0.760	0.279	0.289	−0.368	0.369
	P		<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
PLR	r	0.394	1.000	0.879	0.295	0.289	−0.271	0.366
	P	<0.001		<0.001	<0.001	<0.001	<0.001	<0.001
NLR–PLR	r	0.760	0.879	1.000	0.353	0.353	−0.390	0.449
	P	<0.001	<0.001		<0.001	<0.001	<0.001	<0.001
PI	r	0.279	0.295	0.353	1.000	0.972	−0.289	0.867
	P	<0.001	<0.001	<0.001		<0.001	<0.001	<0.001
mGPS	r	0.289	0.289	0.353	0.972	1.000	−0.324	0.861
	P	<0.001	<0.001	<0.001	<0.001		<0.001	<0.001
PNI	r	−0.192	−0.127	−0.195	−0.210	−0.252	1.000	−0.225
	P	0.005	0.062	0.004	0.002	<0.001		0.001
CRP	r	0.369	0.366	0.449	0.867	0.861	−0.329	1.000
	P	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Abbreviations: CRP, C-reactive protein; HCC, hepatocellular carcinoma; mGPS, modified Glasgow Prognostic Score; NLR, neutrophil to lymphocyte ratio; NLR–PLR, neutrophil/platelet-to-lymphocyte ratio; PI, prognostic index; PLR, platelet-to-lymphocyte ratio; PNI, prognostic nutritional index; TACE, transarterial chemoembolization.

Figure 1 Kaplan–Meier curves for OS in patients who were diagnosed with HCC after TACE therapy; patients were stratified according to the inflammation-based prognostic scores.

Note: (A) NLR; (B) PLR; and (C) NLR–PLR.

Abbreviations: HCC, hepatocellular carcinoma; NLR, neutrophil-to-lymphocyte ratio; NLR–PLR, neutrophil/platelet-to-lymphocyte ratio; OS, overall survival; PLR, platelet-to-lymphocyte ratio; TACE, transarterial chemoembolization.

Table 3 Univariate and multivariate analyses of OS in the study cohort

Characteristic	Parameter	Univariate analysis		Multivariate analysis
		HR (95% CI)	P	HR (95% CI)	P
Age	<60/60	0.94 (0.64–1.38)	0.749		NI
Gender	Male/female	1.03 (0.55–1.90)	0.931		NI
WBC (×10^9/L)	<10/≥10	0.46 (0.15–1.44)	0.182		NI
Neutrophil (×10^9/L)	<6.3/≥6.3	1.11 (0.667–1.85)	0.684		NI
Lymphocyte (×10^9/L)	<3.2/≥3.2	0.05 (0.00–209.71)	0.479		NI
PLT (×10^9/L)	<100/100–300/≥300	1.08 (0.75–1.57)	0.669		NI
CRP (mg/L)	<8/≥8	2.66 (1.85–3.82)	<0.001	1.48 (0.98–2.21)	0.060
ALT (U/L)	<40/≥40	1.28 (0.90–1.83)	0.171		NI
AST (U/L)	<45/≥45	2.19 (1.44–3.32)	<0.001	0.94 (0.60–1.48)	0.791
ALB (g/L)	<35/≥35	0.62 (0.40–0.97)	0.036	0.74 (0.47–1.18)	0.217
TBIL (mmol/L)	<20.5/≥20.5	1.43 (0.97–2.12)	0.073		NI
ALP (U/L)	<100/≥100	1.95 (1.30–2.90)	0.001	1.20 (0.79–1.83)	0.393
GGT (U/L)	<50/≥50	2.84 (1.39–5.82)	0.004	1.08 (0.51–2.32)	0.836
AFP (ng/mL)	<400/≥400	2.17 (1.54–3.05)	<0.001	1.68 (1.18–2.40)	0.004
HBV-DNA (IU/mL)	<100/≥100	0.97 (0.66–1.43)	0.866		NI
Tumor diameter (cm)	<5/≥5	11.73 (4.33–31.76)	<0.001	6.77 (2.43–18.84)	<0.001
Tumor number	Single/multiple	1.53 (0.95–2.46)	0.081		NI
Vascular invasion	Absent/present	2.44 (1.74–3.43)	<0.001	2.03 (1.43–2.88)	<0.001
HBV infection	Absent/present	0.49 (0.197–1.20)	0.116		NI
NLR–PLR	1/2/3	1.85 (1.41–2.42)	<0.001	1.33 (1.00–1.77)	0.045

Abbreviations: AFP, α-fetoprotein; ALB, albumin; ALT, alanine transaminase; AST, aspartate aminotransferase; CRP, C-reactive protein; GGT, gamma-glutamyl transpeptidase; HBV-DNA, hepatitis B virus DNA; NI, not included; NLR–PLR, neutrophil/platelet-to-lymphocyte ratio; PLT, platelet; OS, overall survival; TBIL, total bilirubin; WBC, white blood cell count.

Figure 2 Comparisons of the AUROC values for OS stratified by the inflammation-based prognostic scores at 1-year (A), 2-year (B), and 3-year (C).

Abbreviations: AUROC, area under the ROC curves; NLR, neutrophil-to-lymphocyte ratio; NLR–PLR, neutrophil/platelet-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; OS, overall survival.

Table 4 Comparison of the AUROC values among the NLR, PLR, and NLR–PLR scores

Inflammation- based score		Time
	1-year	2-year	3-year
NLR	0.643	0.637	0.669
PLR	0.572	0.589	0.606
NLR–PLR	0.644	0.653	0.681

Abbreviations: AUROC, area under the ROC curves; NLR, neutrophil-to-lymphocyte ratio; NLR–PLR, neutrophil/platelet-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio.