Are the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Reliable Predictive Factors of Response and Overall Survival in Egyptian Hepatocellular Cancer Patients Treated with Transarterial Chemoembolization?

Background: Transarterial chemoembolization is approved treatment for hepatocellular carcinoma. It is difficult to antici-pate how a tumor will respond to therapy so finding a baseline biomarker may help tailor treatment and identify patients who need frequent follow-up or more aggressive treatment. Inflammatory ratios such as neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte (PLR), may be used as quan-titative biomarkers for the assessment of individual tumors. Aim of Study: The aim of this study is to analyze the pre-dictive relevance of pretreatment NLR and PLR in patients with HCC undergoing trans-arterial chemoembolization. This is one of few studies that evaluates these factors in an Egyptian population with HCC. Patients and Methods: This is a retrospective study on 57 patients with HCC from Kasr Al-Ainy Hospital, Cairo Univer-sity, Egypt who underwent TACE from 2020 till 2023. Data included laboratory reports such as CBC, liver func-tions, coagulation profile and alpha fetoprotein as well as de-mographic data. Multiphasic imaging was done to assess response using mRECIST criteria. From patients’ initial visits to the HCC clinic until their death or end of study, overall survival was determined. Results: Demographic criteria showed an average age of 60.51 years with male predominance. NLR and PLR showed a median of 1.97 and 95.08 respectively. Predictors of response to therapy and survival showed that only poor performance status was a predictor of no response to TACE. However, NLR and PLR were not shown to have a di-rect association with either response nor survival. In addition, ROC curves were plotted to detect an estimate cut off for both ratios for prediction of response and survival and the maxi-mum scores obtained for prediction of mortality were 0.536 and 0.533 for NLR and PLR respectively while area under curve for prediction of response was 0.535 and 0.506 for NLR and PLR respectively. Conclusion: The current study shows no value for NLR and PLR in prediction of survival or response to TACE in pa-tients with HCC.