NLR-PALBI Score and Its Grading: Predicting Overall Survival of Patients with Primary Liver Cancer Undergoing
Maoyuan Zhang1, Jiyun Zhang1, Kunlong Yang1
1Department of Gastroenterology, The Third Affiliated Hospital of Guangxi University of Chinese Medicine, Liuzhou, Guangxi Zhuang Autonomous Region, 545000, People's Republic of China.
Background:
Transcatheter arterial chemoembolisation (TACE) is the main first-line treatment regimen for advanced unresectable primary liver cancer (PLC), yet there is significant heterogeneity in patient prognosis. The postoperative platelet-albumin-bilirubin (PALBI) score can assess liver reserve function, and the neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammatory status. At present, there are insufficient studies on the predictive value of the combined NLR-PALBI score and its grading for overall survival (OS) in PLC patients after TACE.
Aim Of The Study:
To investigate the prognostic performance of postoperative NLR-PALBI score and grading for OS in PLC patients treated with TACE.
Patients And Methods:
This was a retrospective cohort study enrolling 112 PLC patients who received TACE in our hospital from March 2017 to October 2019 and met the inclusion and exclusion criteria. Among them, 97 were male (86.61%) and 15 were female (13.39%), with a mean age of 54.26 years. The optimal cut-off values of postoperative NLR (6.97) and PALBI score (-1.65) were determined via receiver operating characteristic (ROC) curve, and the NLR-PALBI score and grading system (Grade I: 0 points, Grade II: 1 point, Grade III: 2 points) were constructed. ROC curve, Kaplan-Meier survival analysis and Cox proportional hazards regression model were applied to evaluate the prognostic value of each indicator and screen independent influencing factors of OS.
Results:
ROC curve analysis showed that the NLR-PALBI score had an AUC of 0.776, which was significantly higher than that of single NLR (AUC=0.741) and PALBI score (AUC=0.709) (P<0.01), with a sensitivity of 66.7% and a specificity of 89.1%. Multivariate Cox regression analysis confirmed that postoperative NLR (HR=1.573, 95% CI 1.011-2.446, P=0.005) and NLR-PALBI score (HR=1.656, 95% CI 1.398-1.961, P=0.044) were independent risk factors for poor prognosis in PLC patients. Kaplan-Meier analysis revealed that patients with NLR-PALBI Grade III had the shortest OS, with 1-year, 3-year and 5-year OS rates of 71.43%, 4.76% and 0%, respectively (P<0.01).
Conclusion:
Both postoperative NLR and NLR-PALBI score are independent risk factors for OS in PLC patients treated with TACE. The NLR-PALBI score has superior prognostic predictive value to single indicators, and patients with NLR-PALBI Grade III have the worst prognosis.
