The Pretreatment Neutrophil-to-Lymphocyte Ratio (NLR) as a Near-term Prognostic Indicator in Patients with Locally Advanced Hepatocellular Carcinoma Treated with Hepatic Artery Infusion Chemotherapy: A Propensity Score Matching Cohort Study

Abstract

Abstract Objectives To investigate the value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) for predicting the near-term efficacy of hepatic arterial infusion chemotherapy (HAIC) in patients with locally advanced hepatocellular carcinoma (HCC). Methods In this retrospective study, data were collected from locally advanced HCC patients treated with HAIC between January 2018 and June 2022. Patients were categorized based on their pretreatment NLRs and analyzed via propensity score matching (PSM). The primary study endpoints were the objective response rate (ORR), progression-free survival (PFS), and safety. Results This study included 104 patients. Using X-tile software, the optimal pretreatment NLR cutoff was 2.90, and patients were divided into a high NLR subgroup (>2.9) (n=44 patients) and a low NLR subgroup (≤2.9) (n=60 patients). Following PSM, 43 matched pairs were analyzed. Patients with a low pretreatment NLR exhibited a significantly greater ORR (69.8% vs 37.2%, P=0.002) and improved PFS (6.7 months vs 3.8 months, P=0.007) than did those with a high NLR. Both univariate and multivariate regression analyses demonstrated that a high pretreatment NLR is an independent negative prognostic factor for ORR ([HR], 3.464; 95% CI, 1.383-8.678; P=0.008) and PFS ([HR], 1.634; 95% CI, 1.026-2.600; P=0.038). No significant differences in the incidence of adverse events (AEs) were observed between the groups. Conclusion The pretreatment NLR is a readily obtainable and effective biomarker for predicting the near-term efficacy of HAIC in patients with locally advanced HCC.