The Pretreatment Neutrophil-to-Lymphocyte Ratio as a Near-Term Prognostic Indicator in Patients with Locally Advanced Hepatocellular Carcinoma Treated with Hepatic Arterial Infusion Chemotherapy: A Propensity Score Matching Cohort Study

Aims/Background To investigate the predictive value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) for estimating the near-term efficacy of hepatic arterial infusion chemotherapy (HAIC) in patients with locally advanced hepatocellular carcinoma (HCC). Methods In this retrospective study, data were collected from patients with locally advanced HCC treated with HAIC between January 2018 and June 2022. Patients were categorized based on their pretreatment NLRs and analyzed using propensity score matching (PSM). The primary endpoints in this study were objective response rate (ORR), progression-free survival (PFS), and safety. Results The optimal pretreatment NLR cutoff was 2.90 using the X-tile software (version 3.6.1; Yale Corp., New Haven, CT, USA), and 104 patients were included. These patients were divided into a high-NLR subgroup (>2.9; n = 44) and a low-NLR subgroup (<= 2.9; n = 60). 43 matched pairs were analyzed following PSM. PFS (6.7 months vs. 3.8 months, p = 0.007) and ORR (69.8% vs. 37.2%, p = 0.002) were significantly higher in patients with a low pretreatment NLR than in patients with a high pretreatment NLR. Both univariate and multivariate regression analyses demonstrated that a high pretreatment NLR was an independent negative prognostic factor for ORR (hazard ratio [HR], 3.464; 95% CI, 1.383-8.678; p = 0.008) and PFS (HR, 1.634; 95% CI, 1.026-2.600; p = 0.038). No significant differences in the incidence of adverse events were observed between the groups. Conclusion Pretreatment NLR is a readily obtainable and effective biomarker for predicting the near-term efficacy of HAIC in patients with locally advanced HCC.