Diabetes mellitus and the neutrophil to lymphocyte ratio predict overall survival in non-viral hepatocellular carcinoma treated with transarterial chemoembolization.

Jiangguo Zhang,Jianxin Song,Fengyun Gong,Ling Li,Manzhi Zhao

doi:10.3892/ol.2014.1896

Abstract

Diabetes mellitus (DM) and systemic inflammation are closely associated with the development of hepatocellular carcinoma (HCC). However, the prognostic significance of DM on HCC remains controversial. The main purpose of the present study was to evaluate the effects of DM and the systemic inflammation-based neutrophil to lymphocyte ratio (NLR) on the overall survival (OS) rate of non-viral HCC patients treated with transarterial chemoembolization (TACE). A retrospective analysis of 138 patients with HCC, who were diagnosed between 2002 and 2012 with non-viral causes and who later underwent TACE, was performed. Among these patients, 34 (24.6%) had pre-existing DM and 46 (33.3%) exhibited an elevated baseline NLR (≥5). The multivariate analysis showed that DM, the NLR and a portal vein tumor thrombus (PVTT) were independent predictors for a poor OS rate (P<0.05). The patients with DM and an elevated NLR exhibited a poorer OS rate when compared with patients without these factors. In addition, there was a significant stepwise improvement in the OS rate of patients with DM and an elevated NLR, and in patients with only one of these factors compared with patients without either (P<0.01). Finally, DM was significantly correlated with PVTT and elevated γ-glutamyl transpeptidase levels, while the NLR was independently associated with PVTT and tumor multiplicity (P<0.05). The present study revealed that DM, baseline NLR and PVTT are independent indicators of the OS rate in non-viral HCC patients treated with TACE. DM and NLR may affect the OS rate by promoting the malignant progression of HCC. The combination of DM and NLR appears to be a stronger predictor for OS than DM or NLR alone.

Highlights

Hepatocellular carcinoma (HCC), the sixth most common cancer on a global scale, is the third major cause of cancer‐related mortalities and causes ~598,000 fatalities annually [1]
The present study revealed that Diabetes mellitus (DM), baseline neutrophil to lymphocyte ratio (NLR) and portal vein tumor thrombus (PVTT) are independent indicators of the overall survival (OS) rate in non‐viral HCC patients treated with Transarterial chemoembolization (TACE)
In recent years, ~81.5% of HCCs have been correlated with chronic viral infection [hepatitis B virus (HBV) and hepatitis C virus (HCV) infection], whereas 18.5% have been associated with non‐viral causes [HBV surface antigen (HBsAg)‐negative and HCV antibody (Ab)‐negative] in mainland China [2]

Summary

Introduction

Hepatocellular carcinoma (HCC), the sixth most common cancer on a global scale, is the third major cause of cancer‐related mortalities and causes ~598,000 fatalities annually [1]. In recent years, ~81.5% of HCCs have been correlated with chronic viral infection [hepatitis B virus (HBV) and hepatitis C virus (HCV) infection], whereas 18.5% have been associated with non‐viral causes [HBV surface antigen (HBsAg)‐negative and HCV antibody (Ab)‐negative] in mainland China [2]. For areas in which HBV infection is prevalent, including China, the HBV vaccine has dramatically decreased the incidence of HBV‐related HCC [3]. Recent developments in the management of patients infected with HBV and/or HCV by specific antiviral therapy, including interferon and nucleotide analogues, has led to a decrease of viral infection‐related HCC development and improved its prognosis [4,5]. Transarterial chemoembolization (TACE) is the first‐line of treatment for unresectable HCC, and randomized controlled trials have confirmed its benefits in improving the median survival rate [9]

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