Purpose: Patients with hepatocellular carcinoma (HCC) who might benefit most from anti-angiogenesis therapy remain unknown. In recent years, neutrophil-to-lymphocyte ratio (NLR), an indicator of inflammatory response, has received particular attention in HCC. Herein, we explored the prognostic value of pre-treatment NLR in individuals with unresectable intermediate and advanced hepatocellular carcinoma treated with apatinib, a second-line angiogenesis inhibitor. The findings of this study would assist in precision medicine and provide clinical decision support.
Patients and Methods: This is a retrospective study in which 171 HCC patients attending Tianjin Medical University Cancer Institute and Hospital and treated with apatinib between January 2016 and July 2018 were enrolled. The prognosis of the patients based on NLR signatures was then analyzed.
Results: Patients with a low pre-treatment NLR (NLR < 2.49) presented a significantly longer overall survival (OS) (P < 0.001) and progression-free survival (PFS) (P = 0.043). Furthermore, a low pre-treatment NLR level could be used to predict a longer OS in patients with non-macrovascular invasion (P < 0.001). Independent of serum alpha-fetoprotein (AFP) levels, a low NLR level in this cohort of patients is associated with a longer OS.
Conclusion: Pre-treatment NLR predicts the prognosis of patients with unresectable intermediate and advanced HCC treated with apatinib.

Keywords: hepatocellular carcinoma, vascular endothelial growth factor receptor - 2, neutrophil to lymphocyte ratio, tyrosine protein kinases inhibitor


中文翻译：

---

中性粒细胞与淋巴细胞的比率 (NLR) 可预测用阿帕替尼治疗的不可切除的中晚期和晚期肝细胞癌的预后

目的：可能从抗血管生成治疗中获益最多的肝细胞癌 (HCC) 患者仍然未知。近年来，作为炎症反应指标的中性粒细胞与淋巴细胞比率（NLR）在HCC中受到了特别关注。在此，我们探讨了治疗前 NLR 在用二线血管生成抑制剂阿帕替尼治疗的不可切除的中晚期肝细胞癌患者中的预后价值。这项研究的结果将有助于精准医学并提供临床决策支持。
患者和方法：这是一项回顾性研究，纳入了 2016 年 1 月至 2018 年 7 月期间在天津医科大学肿瘤研究所和医院接受阿帕替尼治疗的 171 名 HCC 患者。然后分析基于 NLR 特征的患者预后。
结果：治疗前 NLR 较低 (NLR < 2.49) 的患者总生存期 (OS) (P < 0.001) 和无进展生存期 (PFS) (P = 0.043) 显着延长。此外，较低的治疗前 NLR 水平可用于预测非大血管侵犯患者的较长 OS（P < 0.001）。与血清甲胎蛋白 (AFP) 水平无关，这组患者的低 NLR 水平与较长的 OS 相关。
结论：治疗前 NLR 可预测接受阿帕替尼治疗的不可切除的中晚期 HCC 患者的预后。

关键词：肝细胞癌，血管内皮生长因子受体-2，中性粒细胞与淋巴细胞的比例，酪氨酸蛋白激酶抑制剂