Inflammatory Scores: Correlation with Clinical Outcomes in Hepatocellular Carcinoma Patients Undergoing Transarterial Radioembolization

Purpose: To evaluate the ability of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), aspartate aminotransferase-to-lymphocyte ratio (ALRI) and systemic-inflammation index (SII) to predict clinical outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial radioembolization (TARE). Materials and Methods: One hundred forty-five patients who underwent treatment of 167 HCCs had their pretreatment and 1 month post treatment laboratory values evaluated. Overall survival (OS), progression-free survival (PFS) and local PFS models were performed with patients separated by median inflammatory scores. Results: The median pretreatment NLR, PLR, ALRI and SII were 3.0 (range: 0.5–176), 104.4 (range: 25–830), 55.7 (range: 7.5–2090) and 360.2 (range: 51.1–7207.8), respectively. While the median post treatment NLR, PLR, ALRI and SII were 6.2 (range: 0.4–176), 180 (range: 35–2100), 125 (range: 15.9–5710) and 596.8 (range: 28.9–19,320), respectively. OS models showed significant differences when separating the groups by median post treatment NLR (p = 0.003) and SII (p = 0.003). Multivariate Cox regression models for OS with all pre and post treatment inflammatory markers (log-scale) as well as tumor size, AFP and Child–Pugh score showed significant pretreatment NLR [HR: 0.22 (95% CI:0.06–0.75), p = 0.016] and SII [3.52 (95% CI: 1.01–12.3), p = 0.048], as well as post treatment NLR [6.54 (95% CI: 1.57–27.2), p = 0.010] and SII [0.20 (95% CI: 0.05–0.82), p = 0.025] association. The post treatment ALRI (p = 0.010) correlated with PFS while, post treatment NLR (p < 0.001), ALRI (p = 0.024) and SII (p = 0.005) correlated with local PFS. Conclusion: Pretreatment and post treatment NLR and SII may be associated with OS and post treatment ALRI may be associated with both PFS and local PFS in HCC patients undergoing TARE.