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Yoneoka et al. Hepatoma Res 2020;6:67 Hepatoma Research
DOI: 10.20517/2394-5079.2020.57

Original Article Open Access

Prognostic ability of inflammation-based markers in
radioembolization for hepatocellular carcinoma

Grant Yoneoka , Kliment Bozhilov , Linda L. Wong 1,2
1
1,2
1 Transplant Center, The Queen’s Medical Center, Honolulu, HI 96813, USA.
2 Department of Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI 96813, USA.
Correspondence to: Dr. Linda L. Wong, Department of Surgery, University of Hawaii, John A. Burns School of Medicine, 550
South Beretania Street, Suite 403, Honolulu, HI 96813, USA. E-mail: hepatoma@aol.com
How to cite this article: Yoneoka G, Bozhilov K, Wong LL. Prognostic ability of inflammation-based markers in radioembolization
for hepatocellular carcinoma. Hepatoma Res 2020;6:67. http://dx.doi.org/10.20517/2394-5079.2020.57
Received: 5 Jun 2020 First Decision: 5 Aug 2020 Revised: 18 Aug 2020 Accepted: 31 Aug 2020 Published: 12 Oct 2020

Academic Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: Inflammation-based markers, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte
Received: First Decision: Revised: Accepted: Published:
ratio (PLR), have recently been used as prognostic indicators in hepatocellular carcinoma (HCC). We aimed to
Science Editor: Copy Editor: Production Editor: Jing Yu determine whether NLR and PLR may predict response to yttrium-90 transarterial radioembolization (TARE) as
primary treatment for HCC.

Methods: We performed a retrospective review of a prospectively collected database of HCC cases (1994-2019)
and selected patients who received TARE as primary treatment (n = 42). Laboratory studies were used to calculate
NLR and PLR. Response to TARE was determined using the modified response evaluation criteria in solid tumors
(mRECIST). Patients were classified as non-responders (stable or progressive disease) or responders (partial or
complete response) to treatment based on mRECIST.

Results: Receiver operating characteristic curves identified a pre-treatment NLR cutoff of ≥ 2.83 and a pre-
treatment PLR cutoff of ≥ 83 for predicting non-response to treatment. Pre-treatment NLR ≥ 2.83 was the only
significant predictor of non-response to TARE in multivariate logistic regression analysis (odds ratio 7.83, P
= 0.036). On time to progression analysis, both pre-treatment NLR ≥ 2.83 and pre-treatment PLR ≥ 83 were
associated with a higher proportion of tumor progression at 6 months post-treatment (43.6% vs . 10.0%, P =
0.014, log-rank) and (38.6% vs. 0%, P = 0.010, log-rank), respectively.

Conclusion: NLR confers prognostic value and may be superior to PLR in determining response to TARE as primary
treatment for HCC. Future studies are necessary to validate these findings in a larger cohort.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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