A Novel Neutrophil-to-Lymphocyte Ratio and Sarcopenia Based TACE-Predict Model of Hepatocellular Carcinoma Patients

Abstract

Shangyuan Wang, Xuanpu Zhang, Qi Chen, Zhi-Cheng Jin, Jian Lu, Jinhe Guo Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, People’s Republic of ChinaCorrespondence: Jian Lu; Jinhe Guo, Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, People’s Republic of China, Tel [phone], Email [email protected]; [email protected]: Transarterial chemoembolization (TACE) was commonly applied in hepatocellular carcinoma (HCC) patients across BCLC A-C stages with heterogeneous outcomes in real-world practice. We aimed to develop a neutrophil-to-lymphocyte ratio (NLR) and sarcopenia-based prognostic nomogram to estimate the prognosis of HCC patients after TACE treatment.Patients and Methods: Between June 2013 and December 2019, a total of 364 HCC patients who underwent TACE were included and randomly assigned to the training (n=255) and the validation cohort (n=109). Sarcopenia was diagnosed based on the third lumbar vertebra skeletal muscle mass index (L3-SMI). The multivariate Cox proportional risk model was used to generate a nomogram.Results: NLR ≥ 4.0, sarcopenia, alpha-fetoprotein (AFP) ≥ 200 ng/mL, albumin-bilirubin (ALBI) grade 2 or 3, number of lesions (≥ 2), and maximum size of the lesion (≥ 5 cm) were independent predictors for overall survival (OS) (P < 0.05). The calibration curve shows that the predicted results agree well with the observed results. The time-dependent areas under the receiver-operating characteristic curves for OS at 1, 2, and 3 years predicted by the nomogram were 0.818/0.827, 0.742/0.823, and 0.748/0.836 in both training and validation cohorts. Nomogram can divide patients into low-, medium- and high-risk groups based on predictor factors. The C-indexes of the nomogram for OS were 0.782/0.728 in the training and validation cohorts, outperforming other currently available models.Conclusion: A novel nomogram based on NLR and sarcopenia may be useful to predict the prognosis of HCC patients who underwent TACE across BCLC A-C stage patients.Keywords: hepatocellular carcinoma, transarterial chemoembolization, neutrophil-to-lymphocyte ratio, sarcopenia, albumin-bilirubin, nomogram

Keywords

• hepatocellular carcinoma
• transarterial chemoembolization
• neutrophil-to-lymphocyte ratio
• sarcopenia
• albumin-bilirubin
• nomogram