Predictive Value of Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte ratio in Advanced Hepatocellular Carcinoma Treated with Sorafenib Monotherapy or Combined with Radioembolization

Background To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with advanced HCC treated with sorafenib monotherapy or radioembolisation/sorafenib combination.

Methods Patients randomized to sorafenib monotherapy or radioembolisation/sorafenib within the per-protocol population of SORAMIC trial were evaluated in this exploratory post-hoc analysis. The median baseline value of NLR and PLR were used as cut-off values to describe subgroups. Kaplan-Meier curves with log-rank tests were used to evaluate the median survival of sorafenib and radioembolisation/sorafenib arms in each subgroup. Multivariable Cox regression analysis was applied to eliminate the effect of confounding factors.

Results A total of 274 patients with a median overall survival of 12.4 months were included in this analysis. The median NLR value of the cohort was 2.77, and PLR was 26.5. There was no significant difference in the overall survival of sorafenib and radioembolisation/sorafenib arms in patients with low NLR (p=0.72) and PLR (p=0.35) values. In patients with high NLR values, there was no statistically significant difference in the median overall survival between radioembolisation/sorafenib and sorafenib cohorts (12.1 vs. 9.2 months, p=0.21). In patients with high PLR values, the overall survival in SIRT/sorafenib arm was significantly longer than in the sorafenib arm (15.9 vs. 11.0 months, p=0.029). This significant difference was preserved in the multivariable analysis (radioembolisation /sorafenib arm HR 0.65 [0.44-0.96], p=0.03) incorporating age, Child-Pugh grade, and alpha-fetoprotein levels.

Conclusions PLR is a potential predictive factor of benefit from additional SIRT in HCC patients receiving sorafenib therapy.

Publication History

Article published online:
20 January 2025