Predictive Value of Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte ratio in HCC Treated with Sorafenib and Radioembolization

Background & AimsTo explore the predictive value of systemic inflammatory markers (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) in patients with advanced HCC treated with sorafenib monotherapy or selective internal radiation therapy (SIRT)/sorafenib combination.MethodsPatients randomized to sorafenib monotherapy or SIRT/sorafenib within the per-protocol population of SORAMIC trial were evaluated in this exploratory post-hoc analysis. The median baseline value of NLR and PLR were used as cut-off values to describe subgroups. Kaplan-Meier curves with log-rank tests were used to evaluate the median survival of sorafenib and SIRT/sorafenib arms in each subgroup. Multivariable Cox regression analysis was applied to eliminate the effect of confounding factors.ResultsA total of 274 patients with a median overall survival of 12.4 months were included in this analysis. The median NLR value of the cohort was 2.77, and PLR was 26.5. There was no significant difference in the overall survival of sorafenib and SIRT/sorafenib arms in patients with low NLR (p=0.72) and PLR (p=0.35) values. In patients with high NLR values, there was no statistically significant difference in the median overall survival between SIRT/sorafenib and sorafenib cohorts (12.1 vs. 9.2 months, p=0.21). In patients with high PLR values, the overall survival in SIRT/sorafenib arm was significantly longer than in the sorafenib arm (15.9 vs. 11.0 months, p=0.029). This significant difference was preserved in the multivariable analysis (SIRT/sorafenib arm HR 0.65 [0.44-0.96], p=0.03) incorporating age, Child-Pugh grade, and alpha-fetoprotein levels.ConclusionsPLR is a potential predictive factor of benefit from additional SIRT in HCC patients receiving sorafenib therapy. Potential predictive value of PLR should be further evaluated in future trials.Impact and implicationsSystemic therapies are mainstay treatment in patients with hepatocellular carcinoma at advanced stages. However, not all patients respond well to these treatments. In our analysis, using blood test parameters showing systemic inflammation status, we were able to identify patients who would benefit more from combined treatment with a locoregional treatment of radioembolization (or selective internal radiation therapy).