A Novel Neutrophil-to-Lymphocyte Ratio and Sarcopenia Based TACE-Predict Model of Hepatocellular Carcinoma Patients

Shangyuan Wang; Xuanpu Zhang; Qi Chen; Zhi-Cheng Jin; Jian Lu; Jinhe Guo

doi:10.2147/JHC.S407646

A Novel Neutrophil-to-Lymphocyte Ratio and Sarcopenia Based TACE-Predict Model of Hepatocellular Carcinoma Patients

J Hepatocell Carcinoma. 2023 Apr 20:10:659-671. doi: 10.2147/JHC.S407646. eCollection 2023.

Authors

Shangyuan Wang¹, Xuanpu Zhang¹, Qi Chen¹, Zhi-Cheng Jin¹, Jian Lu¹, Jinhe Guo¹

Affiliation

¹ Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, People's Republic of China.

Abstract

Purpose: Transarterial chemoembolization (TACE) was commonly applied in hepatocellular carcinoma (HCC) patients across BCLC A-C stages with heterogeneous outcomes in real-world practice. We aimed to develop a neutrophil-to-lymphocyte ratio (NLR) and sarcopenia-based prognostic nomogram to estimate the prognosis of HCC patients after TACE treatment.

Patients and methods: Between June 2013 and December 2019, a total of 364 HCC patients who underwent TACE were included and randomly assigned to the training (n=255) and the validation cohort (n=109). Sarcopenia was diagnosed based on the third lumbar vertebra skeletal muscle mass index (L3-SMI). The multivariate Cox proportional risk model was used to generate a nomogram.

Results: NLR ≥4.0, sarcopenia, alpha-fetoprotein (AFP) ≥200 ng/mL, albumin-bilirubin (ALBI) grade 2 or 3, number of lesions (≥2), and maximum size of the lesion (≥5 cm) were independent predictors for overall survival (OS) (P < 0.05). The calibration curve shows that the predicted results agree well with the observed results. The time-dependent areas under the receiver-operating characteristic curves for OS at 1, 2, and 3 years predicted by the nomogram were 0.818/0.827, 0.742/0.823, and 0.748/0.836 in both training and validation cohorts. Nomogram can divide patients into low-, medium- and high-risk groups based on predictor factors. The C-indexes of the nomogram for OS were 0.782/0.728 in the training and validation cohorts, outperforming other currently available models.

Conclusion: A novel nomogram based on NLR and sarcopenia may be useful to predict the prognosis of HCC patients who underwent TACE across BCLC A-C stage patients.

Keywords: albumin-bilirubin; hepatocellular carcinoma; neutrophil-to-lymphocyte ratio; nomogram; sarcopenia; transarterial chemoembolization.

Grants and funding

The study was supported by Jiangsu Province Key Research and Development Plan Program (BE2020785, BE2022855), National Natural Science Foundation of China (81827805, 82001935), Zhi-Shan Scholar Program of Southeast University (2242022R40069), and National Key Research and Development Program (2018YFA0704100, 2018YFA0704104). The funders of the study had no role in study protocol design, data analysis and interpretation, or writing of the report.