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Neutrophil-Lymphocyte Ratio Predicts Overall Survival in Patients With HCC Treated With Durvalumab Plus Tremelimumab

  • 1Department of Gastroenterology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan.
  • 2Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
  • 3Department of Gastroenterology, Japanese Red Cross Society Himeji Hospital, Himeji, Japan.
  • 4Department of Nursing, Gifu Kyoritsu University, Gifu, Japan.
  • 5Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
  • 6Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
  • 7Department of Gastroenterology, Okayama City Hospital, Okayama, Japan.
  • 8Department of Gastroenterology and Hepatology, Kagawa University, Kagawa, Japan.
  • 9Division of Gastroenterology and Hepatology, Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
  • 10Department of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan.
  • 11Department of Gastroenterology, Asahi General Hospital, Chiba, Japan.
  • 12Department of Internal Medicine, Division of Gastroenterology and Hepatology, Hyogo Medical University, Hyogo, Japan.
  • 13Department of Gastroenterology, Osaka Medical and Pharmaceutical University, Osaka, Japan.
  • 14Center of Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan.
  • 15Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan.
  • 16Department of Gastroenterology, Toyama University Hospital, Toyama, Japan.
  • 17Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
  • 18Department of Gastroenterology, Japanese Red Cross Takamatsu Hospital, Kagawa, Japan.
  • 19Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Gunma, Japan.
  • 20Department of Clinical Research, NHO Takasaki General Medical Center, Gunma, Japan.
  • 21Department of Hepatology, Hamamatsu University School of Medicine, Shizuoka, Japan.
  • 22Department of Surgery, Kansai Medical University, Osaka, Japan.
  • 23Department of Gastroenterology, NHO Takasaki General Medical Center, Gunma, Japan.
  • 24Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan.
  • 25Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
  • 26Department of Gastroenterology, Hanwa Memorial Hospital, Osaka, Japan.
  • 27Department of Hepatology, Wakayama Rosai Hospital, Wakayama, Japan.
  • 28Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
  • 29Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan.
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June 14, 2025

Abstract

AIM

To investigate the prognostic impact of the neutrophil-to-lymphocyte ratio (NLR) on outcomes in patients with hepatocellular carcinoma (HCC) treated with durvalumab plus tremelimumab (Dur/Tre).

METHODS

A total of 182 patients with HCC who received Dur/Tre were included in the analysis. Univariate and multivariate survival analyses were conducted. Additionally, hazard ratio (HR) spline curve analysis was used to determine the optimal NLR cut-off values for predicting overall survival (OS).

RESULTS

The median progression-free survival (PFS) was 3.5 months (95% confidence interval [CI]: 2.7-4.4), whereas the median OS was not reached (95% CI: 12.1 months-not reached). Multivariate analysis demonstrated that treatment with Dur/Tre as a second-line therapy or beyond was independently associated with worse PFS (HR: 1.819; 95% CI: 1.230-2.688; p = 0.003). Furthermore, an NLR of ≥ 2.56 was identified as an independent predictor of reduced OS (HR: 1.919; 95% CI: 1.033-3.566; p = 0.039). The median OS was not reached (95% CI: 12.3 months-not reached) in patients with an NLR of < 2.56, compared with 12.1 months (95% CI: 9.0 months-not reached) in those with an NLR of ≥ 2.56 (p = 0.016). A Sankey diagram illustrating post-treatment outcomes revealed that a significantly larger proportion of patients with high NLRs did not proceed to subsequent therapies but instead received best supportive care (p = 0.046). Spline curve analysis showed that an NLR range of approximately 2.3-3.0 represents an appropriate cut-off for predicting OS.

CONCLUSIONS

The NLR is a significant prognostic biomarker for OS in patients with HCC treated with Dur/Tre.

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