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Dynamic changes in the neutrophil-to-lymphocyte ratio predict prognosis in patients with hepatocellular carcinoma undergoing TACE combined with targeted therapy and immunotherapy: a multicenter retrospective study

immunology
oncology
radiology-and-medical-imaging
coupled-natural-and-human-systems

Abstract

Objective
This study aimed to investigate the predictive value of early dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) for treatment response and prognosis in patients with unresectable hepatocellular carcinoma (HCC) receiving transarterial chemoembolization (TACE) combined with targeted therapy and immunotherapy.
Methods
Patients with unresectable hepatocellular carcinoma treated with TACE combined with targeted therapy and immune checkpoint inhibitors between 2021 and 2024 were retrospectively analyzed. Patients were stratified according to early dynamic changes in the NLR. Tumor response was assessed using mRECIST criteria, and survival outcomes were evaluated with Kaplan–Meier analysis and Cox proportional hazards models.
Results
A total of 329 patients were enrolled, including 190 in the NLR decrease group and 139 in the NLR increase group. Patients in the NLR decrease group achieved significantly longer median PFS (12.0 vs. 8.9 months, Log-rank P = 0.010) and OS (20.0 vs. 15.2 months, Log-rank P = 0.011). Multivariate Cox regression analysis identified dynamic changes in NLR as an independent predictor of both PFS (HR = 1.486, 95% CI: 1.119–1.972, P = 0.006) and OS (HR = 1.426, 95% CI: 1.092–1.862, P = 0.009). Compared with the NLR increase group, the NLR decrease group achieved significantly higher ORR and DCR. Treatment-related adverse events were comparable between the two groups.
Conclusion
Dynamic changes in the NLR represent a valuable prognostic indicator for patients with hepatocellular carcinoma receiving TACE combined with targeted therapy and immunotherapy.
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