729P - Impact of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) on outcomes in hepatocellular carcinoma (HCC) patients treate...

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Hepatobiliary Cancers
Translational Research
Basic Principles in the Management and Treatment (of cancer)
Biological Therapy
Presenter Kit Man Wong
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors K.M. Wong1, J. Chiu2, X. Shen3, A.J. Templeton4, W. Xu5, E.X. Chen6, M. Sherman7, R. Feld6, J. Knox6
  • 1Medical Oncology, Princess Margaret Cancer Centre, M5G 2A1 - Toronto/CA
  • 2Medical Oncology, Princess Margaret Cancer Centre, Toronto/CA
  • 3Biostatistics, Princess Margaret Cancer Centre, Toronto/CA
  • 4Medical Oncology, Kantonsspital St. Gallen, CH-9007 - St. Gallen/CH
  • 5Department Of Biostatistics, Princess Margaret Hospital, Ontario Cancer Institute, Toronto/CA
  • 6Dept. Of Medical Oncology And Hematology, Princess Margaret Hospital, M5G 2M9 - Toronto/CA
  • 7Hepatology, University Health Network, Toronto General Hospital, Toronto/CA



Sor is the standard treatment for patients with advanced HCC. However, prognostic and predictive markers are lacking in this population. NLR and PLR are markers of inflammation and poor prognostic factors in many solid tumors. They have not been well studied in the context of Sor therapy in HCC. We evaluated patients with HCC receiving Sor to assess the impact of baseline and changes in NLR/PLR on overall survival (OS) and time to progression (TTP).


NLR/PLR at several time points (pre-Sor, 4 ± 2weeks[w], 8 ± 2w) were retrospectively determined. High (H) and low (L) NLR/PLR were defined by their medians in the cohort. Associations between OS and TTP with pre-Sor and changes in NLR/PLR were analyzed by the log-rank test and Cox proportional hazards model.


132 consecutive HCC patients treated with Sor from Feb 2007 to Dec 2013 were included. Median age was 66 years at the start of Sor. There were 82% males and 51% Asians. Most patients had viral hepatitis (hep B, 44%; hep C, 32%). 85% were Child-Pugh class A and 90% were BCLC stage C. 67% had extrahepatic spread and 35% had macrovascular invasion. The rate of progression on Sor was 52%, while 78% of the cohort had died. The median baseline NLR and PLR were 3.2 and 135, respectively. Median OS for patients with H and L NLR were 6.8 (95% CI 5.6-10.1) and 11.4 (95% CI 7.9-19.7) months (m), respectively (log-rank P = 0.001). Similarly, median OS was 6.5m (95% CI 5.7-11.6) for H PLR and 11.0m (95% CI 7.9-17.7) for L PLR (log-rank P = 0.045). NLR ≥3.2 was significantly associated with poorer OS (HR 1.91, 95% CI 1.28-2.86, P = 0.002), as was PLR ≥135 (HR 1.49, 95% CI 1.01-2.21, P = 0.047). There was no correlation between OS and other clinical variables, including age, sex, ethnicity and etiology. Neither pre-Sor NLR nor PLR correlated with TTP. Absolute changes in NLR/PLR (pre-Sor to 4w and 8w) were not significant and did not affect survival.


Elevated baseline NLR and PLR were significantly associated with worse OS in HCC patients treated with Sor. These systemic inflammatory markers may be prognostic in this population, while we found no predictive value. Validation in larger datasets is warranted.


All authors have declared no conflicts of interest.