Neutrophil-to-lymphocyte ratio predicts therapy outcomes of transarterial chemoembolization combined with tyrosine kinase inhibitors plus programmed cell death ligand 1 antibody for unresectable hepatocellular carcinoma

The objective is to assess the predictive value of preoperative biochemical markers, expressed as neutrophil-to-lymphocyte ratio (NLR), in patients with unresectable hepatocellular carcinoma (uHCC) receiving a combination of tailored tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) plus transarterial chemoembolization (TACE). A total of 95 patients with uHCC treated with TACE + TKIs + ICIs in our hospital between March 2018 and October 2021 were included in this retrospective study. The prognosis of the patients was analyzed based on NLRs. Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were evaluated. Univariate and multivariate analyses were used to determine factors affecting survival. Patients with a low pretreatment NLR (NLR ≤ 2.22) had significantly longer OS (25.8 months vs. 16.4 months; P = 0.000) and PFS (14.0 months vs. 11.1 months; P = 0.002). In multivariate analysis, two independent factors affecting PFS were identified: hepatitis B virus infection and NLR. Three independent factors affected OS: tumor size, Eastern Cooperative Oncology Group performance, and NLR. All AEs were tolerable, whereas NLR could be suspected as an indicator of immunotherapy-related AEs. A lower pretreatment NLR (≤2.22) might indicate a better prognosis for patients with uHCC treated with TACE + TKIs + ICIs. NLR could provide better guidance for clinicians when evaluating the prognosis of patients with uHCC treated with TACE + TKIs + ICIs and making clinical treatment decisions.