Usefulness of neutrophil‐to‐lymphocyte ratio in predicting progression and survival outcomes after atezolizumab–bevacizumab treatment for hepatocellular carcinoma
Hironori Ochi, Masayuki Kurosaki, Kouji Joko, Toshie Mashiba, Nobuharu Tamaki, Kaoru Tsuchiya, Hiroyuki Marusawa, Toshifumi Tada, Shinichiro Nakamura, Ryoichi Narita, Yasushi Uchida, Takehiro Akahane, Masahiko Kondo, Nami Mori, Shintaro Takaki, Keiji Tsuji, Atsunori Kusakabe, Koichiro Furuta, Haruhiko Kobashi, Hirotaka Arai, Michiko Nonogi, Takashi Tamada, Chitomi Hasebe, Namiki Izumi
Abstract
AIM: We investigated pretreatment neutrophil-to-lymphocyte ratio (NLR) for predicting survival outcomes of atezolizumab plus bevacizumab therapy for hepatocellular carcinoma (HCC) and determined the predictive ability of combined liver reserve-NLR. METHODS: This retrospective, multicenter study enrolled 242 patients receiving atezolizumab plus bevacizumab for unresectable HCC. Pretreatment NLR <2.56 was designated as the "low group" and NLR ≥2.56 as the "high group" (120 and 122 patients, respectively). Propensity score-matched analysis was undertaken between the low and high groups. RESULTS: In this cohort, the objective response and disease control rates were 20% and 72.5%, respectively, in the low group and 19.6% and 72.9%, respectively, in the high group. After matching, median progression-free survival (PFS) time was 283 and 167 days in the low and high groups, respectively (p = 0.022). Neutrophil-to-lymphocyte ratio ≥2.56 (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.05-2.28; p = 0.028), modified albumin-bilirubin index (mALBI) grade 2b or 3 (HR 1.55; 95% CI, 1.05-2.29; p = 0.025), and protein induced by vitamin K absence or antagonist-II ≥ 400 (HR 2.03; 95% CI, 1.36-3.02; p = 0.001) were significantly associated with PFS in univariate analysis using the Cox proportional hazards model. In cases involving mALBI grade 1 or 2a (n = 131), the median PFS time was not reached in the low group, whereas it was 210 days in the high group (p = 0.037). CONCLUSIONS: Pretreatment NLR is a simple tool for routine measurement in clinical practice. It can predict PFS in patients with unresectable HCC treated with atezolizumab plus bevacizumab, especially mALBI grade 1 or 2a.