The Study Of NLR Combined With LMR In Predicting The Prognosis Of Hepatocellular Carcinoma With TACE Treatment

Objective: Hepatocellularn carcinoma(HCC)is a common malignant tumor,Transarterial chemoembolization(TACE)recognized as one of the most commonly used methods for non-surgical treatment of hepatocellular carcinoma,but the prognosis is very different.Neutrophil to lymphocyte ratio(NLR)and Lymphocyte to monocyte ratio(LMR)are confirmed to have predictive value for the prognosis of HCC patients undergoing TACE.However,there is no research report on the combined application of the two in predicting the prognosis of HCC patients after TACE.That’s why this study aims to verify the prognostic value of NLR and LMR after TACE in HCC patients and explore the prognostic value of combined NLR and LMR after TACE in HCC patients.Methods: In this study,general clinical data of 117 HCC patients(February 2017-August 2020)admitted to our hospital and treated with TACE were collected and retrospectively analyzed.The NLR and LMR receiver operating characteristic(ROC)curves are used to determine the optimal threshold of NLR.The result is 3.22,while the optimal threshold of LMR is2.48.Patients are grouped based on the threshold,where NLR>3.22 is divided.In the high NLR group,those with NLR<3.22 are included in the low NLR group;those with LMR>2.48 are included in the high LMR group,and those with LMR<2.48 are included in the low LMR group,and according to the best cut-off value corresponding to NLR and LMR,NLR< 3.22 and NLR≥3.22 are respectively defined as 0 points and 1 points,and LMR≥2.48 and LMR<2.48 are defined as 0 points and 1 points.The sum of the two scores is the NLR-LMR score.All patients are divided into 3 groups: NLR-LMR 0,NLR-LMR 1,NLR-LMR 2.The detailed arera that in the ROC curve of NLR,LMR and NLR-LMR was calculated,and the frognastic valueness of the three in HCC patients after TACE was compared.The survival time with patients is analyzed by KM method,Log-rank test is performed for comparison between groups,single factor analysis and multivariate analysis are performed for variables with statistical value based on the Cox risk ratio model,and the factors affecting postoperative prognosis can be obtained based on this.Including risk factors and independent risk factors.P<0.05 represents a significant difference.Results: Among the 117 HCC patients who received TACE treatment,there are 98 males(83.8%)and 19 females(16.2%),with an average age of56.5±12.8,Hbs Ag positive 94 cases(80.0%),negative 23 cases(19.7%),Child-Pugh grade A grade 112 cases(95.7%),B grade 5 cases(4.3%),and the average tumor diameter was 7.2±4.6cm,49 cases(33.3%)with AFP>400.After drawing the ROC curve,the best cut-off values of NLR and LMR are 3.22 and2.48 respectively.Preoperative NLR and HCC are correlated with tumor size,total bilirubin,and AST.The Kaplan-Meier survival curve shows that patients in the low NLR group have a higher postoperative survival rate,and the survival rate in each period of 1 year and 3 years after surgery is higher than that of the high NLR group.Preoperative LMR is correlated with tumor size,total bilirubin and AST in HCC patients.The Kaplan-Meier survival curve shows that the high LMR group has a higher postoperative survival rate,and the survival rate is higher than that of the low LMR group in each period of 1 and 3years after surgery.Preoperative LMR is correlated with tumor size,total bilirubin and AST in HCC patients.Through the K-M survival curve,it can be found that the patients in the high LMR group have a higher postoperative survival rate,and the corresponding survival rates in each period of 1 year and3 years after the operation are higher than the low LMR group.Preoperative NLR-LMR is correlated with Child-Pugh grade,tumor size,total bilirubin,ALT and AST in HCC patients.According to the survival curve of KM,the median survival time of NLR-LMR 0 group was 36.9 months;the median survival time of NLR-LMR 1 group was 30.5 months,and the median survival time of NLR-LMR 2 group was 20.8 months.-LMR 0 group had the highest overall survival rate(OS),followed by NLR-LMR 1 group,and NLR-LMR 2 group had the lowest.Through univariate analysis,it can be found that tumor size,Child-Pugh grade,NLR,LMR,and NLR-LMR are specifically related to the prognosis of HCC patients;through multivariate COX regression analysis,it can be found that tumor size(P=0.006),Child-Pugh classification(P<0.001)and NLR-LMR 2(P=0.014)are independent risk factors for the prognosis of HCC.The area under the ROC curve shows: the area under the NLR,LMR,and NLR-LMR curve are 0.774,0.773,0.813,respectively(P<0.001).Compared with NLR and LMR alone,NLR-LMR has the largest area under the curve,indicating that it has a better predictive effect.Conclusion: 1.Preoperative NLR,LMR,and NLR-LMR of HCC patients have high predictive value for the prognosis after TACE.The prognosis of HCC patients with high NLR,low LMR,and NLR-LMR 2 before the operation after TACE treatment Poor level.2.NLR-LMR 2 can serve as a prognostic independent risk factor for HCC patients undergoing TACE,and can be used to predict the prognosis of HCC patients after TACE.3.The NLR-LMR score obtained by combining NLR and LMR is better than NLR or LM alone in predicting the prognosis of HCC patients after TACE.