A Study On The Evaluation Value Of NLR And LMR In Evaluating The Efficacy Of TACE Surgery In Patients With HCC Based On Radiology Assessment

Objective:To explore the value of neutrophil to lymphocyte ratio(NLR)and lymphocyte to monocyte ratio(LMR)in evaluating the efficacy of transcatheter chemoembolization(TACE)for the treatment of hepatocellular carcinoma(HCC).Methods:The study included 81 patients diagnosed as hepatocellular carcinoma and received TACE therapy from August 2017 to December 2018 in The Second Hospital of Dalian Medical University.The serological data and imaging data were collected before beginning of treatment,after three days and after one month.The imaging data were collected before beginning of treatment and after one month.All patients were followed up regularly.According to the Modified Response Evaluation Criteria In Solid Tumors(m-RECIST),Compared with the imaging data before and one month after the operation,analyzed the efficacy of operation.Complete remission(CR)and partial remission(PR)were defined as radiological remission,stable disease(SD)and progressive disease(PD)were defined as radiological un-remission,all patients were then divided into two groups.Evaluated the value of NLR and LMR to the efficacy of TACE and predict the long-term prognosis value of patients who treated with TACE.Results: 1.The NLR before operation,three days after operation,one month after operation were respectively:2.71±1.21,6.23±3.63,2.94±2.25.The NLR of the patients three days after operation were higher than that before operation(P < 0.001).The NLR one month after operation were lower than that three days after operation(P < 0.001),and the NLR level one month after operation was closed to that before operation(P=0.373).The LMR before operation,three days after operation,one month after operation were respectively: 4.41±1.74,3.31±3.26,4.17±1.76.The LMR of the patients three days after operation were lower than that before operation(P=0.003).The LMR one month after operation were higher than that three days after operation(P=0.017),and the LMR level one month after operation was closed to that before operation(P=0.190).2.Among the patients in group,there were 34 patients with radiographic remission and 47 patients with radiographic un-remission.The prognostic value of the NLR before operation,three days after operation,one month after operation was compared by analyzing the area under receiver operating characteristics curve(AUC)values,The NLR before operation had a superior discriminative capacity when compared with the other two(AUG=0.692).The optimal cutoff value for NLR before operation was 2.67,with a sensitivity of 55.3% and specificity of79.4%.The prognostic value of the LMR before operation,three days after operation,one month after operation was compared by analyzing the area under receiver operating characteristics curve(AUC)values,The LMR before operation had a superior discriminative capacity when compared with the other two(AUG=0.767).The optimal cutoff value for LMR before operation was 4.10,with a sensitivity of 79.4% and specificity of 68.1%.Accordingly,Patients were divided into the low NLR group(NLR < 2.67),the high NLR group(NLR?2.67),the low LMR group(LMR < 4.10)and the high LMR group(LMR?4.10).The imaging remission rate of the low value NLR group was higher than that of the high value NLR group(P=0.002),and the imaging remission rate of the high value LMR group was higher than that of the low value LMR group(P < 0.001).3.Analyzed the relationship between preoperative NLR,LMR and clinical data of patients with HCC.The correlation analysis showed that there were no statistical connections between preoperative NLR in age,gender,HBs Ag,Child-Pugh grade,portal vein tumor thrombosis,ALB and AST(all P>0.05).The preoperative NLR was correlated with largest tumor size(P=0.005)and AFP(P=0.040).There were no statistical connections between preoperative LMR in age,gender,HBs Ag,largest tumor size,AFP is no significant difference(all P>0.05).The preoperative LMR was correlated with Child-Pugh grade(P = 0.001),and portal vein tumor thrombosis(P = 0.030),Alb(P = 0.020),AST(P = 0.018).4.There were 33 dead and 92 alive at the end of the follow-up.Kaplan-Meir survival curve showed that the survival rate of the low-value NLR group was higher than that of the high-value NLR group,and the survival rate of the high-value LMR group was higher than that of the low-value LMR group.Conclusions: 1.Three days after operation,NLR was higher than that before operation,and The NLR before operation had a superior discriminative capacity to evaluate the efficacy of TACE.The preoperative NLR was correlated with largest tumor size and AFP.The radiological remission rate of patients with low NLR was higher than that of patients with high NLR before operation.2.Three days after the operation,LMR was lower compared with the operation,and The LMR before operation had a superior discriminative capacity to evaluate the efficacy of TACE.The preoperative LMR was correlated with Child-Pugh grade,portal vein tumor thrombosis,Alb and AST.The radiological remission rate of patients with high preoperative LMR was higher than that of patients with low preoperative LMR.3.Combination with NLR,LMR and imaging data showed better value to evaluate the efficacy of TACE treatment and long-term prognosis for HCC patients.Higher NLR and lower LMR operation indicate poor long-term prognosis of patients with HCC.