Usefulness of the Lymphocyte-to-Monocyte Ratio in Predicting Prognosis in Patients with Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab
Aim The lymphocyte-to-monocyte ratio (LMR) has emerged as a potential immune-related biomarker; however, its prognostic significance in patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab plus bevacizumab (Atezo/Bev) remains unclear. To investigate the prognostic significance of the LMR in patients with unresectable HCC treated with Atezo/Bev. Methods This multicentre study included 941 patients with unresectable HCC treated with Atezo/Bev therapy at 30 institutions in Japan. The optimal LMR cutoff value was determined using time-dependent receiver operating characteristic (ROC) analysis. Multivariate survival analyses were performed for progression-free survival (PFS) and overall survival (OS). The prognostic utility of the LMR was compared with that of the neutrophil-to-lymphocyte ratio (NLR) using integrated discrimination improvement and net reclassification improvement. Results Time-dependent ROC analysis identified an optimal LMR cutoff value of 3.6 based on median OS. The median PFS was 5.6 months in patients with an LMR < 3.6 and 8.9 months in those with an LMR ≥ 3.6 (P<0.01). The disease control rate was significantly higher in the high LMR group (P<0.01). Multivariate analysis identified the LMR as an independent factor associated with prolonged PFS (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.90-0.98; P<0.01) and OS (HR, 0.90; 95% CI, 0.85-0.96; P<0.01). Compared with NLR, LMR demonstrated a significantly greater improvement in prognostic predictive performance for both PFS and OS (P<0.01). Conclusions The LMR is a simple and clinically useful prognostic biomarker for predicting both PFS and OS in patients with unresectable HCC treated with Atezo/Bev therapy.
Authors
- Takanori Matsuura (ORCID: https://orcid.org/0009-0008-7361-881X)
- Hideko Ohama (ORCID: https://orcid.org/0000-0002-1882-824X)
- Norio Itokawa (ORCID: https://orcid.org/0009-0002-2390-6692)
- Joji Tani (ORCID: https://orcid.org/0000-0001-8801-2505)
- Kazunari Tanaka (ORCID: https://orcid.org/0000-0001-9811-2665)
- Yuki Kanayama (ORCID: https://orcid.org/0000-0002-8639-5212)
- Tomomitsu Matono
- Hidenao Noritake (ORCID: https://orcid.org/0000-0003-3649-5335)
- Kazuhito Kawata (ORCID: https://orcid.org/0000-0002-4986-8578)
- Kazuya Kariyama (ORCID: https://orcid.org/0000-0003-3996-7502)
- Hidenori Toyoda (ORCID: https://orcid.org/0000-0002-1652-6168)
- Hirayuki Enomoto (ORCID: https://orcid.org/0000-0003-1334-1149)
- Kazuhiro Nouso (ORCID: https://orcid.org/0000-0002-2018-0008)
- Hideyuki Tamai (ORCID: https://orcid.org/0000-0003-4511-4573)
- Takeshi Hatanaka (ORCID: https://orcid.org/0000-0003-3656-285X)
- Masatoshi Kudo (ORCID: https://orcid.org/0000-0002-4102-3474)
- Yoichi Hiasa (ORCID: https://orcid.org/0000-0003-4117-339X)
- Kunihiko Tsuji (ORCID: https://orcid.org/0009-0007-4152-9364)
- Atsushi Hiraoka (ORCID: https://orcid.org/0000-0003-1989-0480)
- Takashi Kumada (ORCID: https://orcid.org/0000-0003-2211-495X)
- Yoshiko Nakamura
- Tomomi Okubo (ORCID: https://orcid.org/0000-0003-1244-4736)
- Takuya Nagano (ORCID: https://orcid.org/0000-0003-1043-8033)
- Ei Itobayashi (ORCID: https://orcid.org/0000-0003-0475-2819)
- Masaki Kaibori (ORCID: https://orcid.org/0000-0002-0577-3921)
- Masashi Hirooka (ORCID: https://orcid.org/0000-0001-5634-5313)
- Chikara Ogawa (ORCID: https://orcid.org/0000-0002-4534-6692)
- Hisashi Kosaka (ORCID: https://orcid.org/0000-0002-2926-9973)
- Emi Tanaka (ORCID: https://orcid.org/0000-0002-0456-2882)
- Kazuto Tajiri (ORCID: https://orcid.org/0000-0002-2373-8601)
- Takashi Nishimura (ORCID: https://orcid.org/0000-0002-5517-8303)
- Toshifumi Tada (ORCID: https://orcid.org/0000-0002-0976-6761)
- Atsushi Naganuma (ORCID: https://orcid.org/0000-0003-0663-0102)
- Akemi Tsutsui (ORCID: https://orcid.org/0000-0003-2978-2723)
- Hidekatsu Kuroda (ORCID: https://orcid.org/0000-0002-1471-1087)
- Toru Ishikawa (ORCID: https://orcid.org/0000-0002-5470-9694)
- Yutaka Yata (ORCID: https://orcid.org/0000-0002-4592-3509)
- Masanori Atsukawa (ORCID: https://orcid.org/0000-0003-3374-7111)
- Yuichi Koshiyama (ORCID: https://orcid.org/0009-0006-1247-1215)
- Tomoko Aoki (ORCID: https://orcid.org/0000-0002-9950-4553)
- Fujimasa Tada (ORCID: https://orcid.org/0009-0007-3964-5876)
- Asahiro Morishita (ORCID: https://orcid.org/0000-0002-0760-3045)
- Koichi Takaguchi (ORCID: https://orcid.org/0000-0003-0175-8721)
- Michitaka Imai (ORCID: https://orcid.org/0000-0001-6448-6036)
- Satoru Kakizaki (ORCID: https://orcid.org/0000-0003-0224-7093)
- Kosuke Matsui (ORCID: https://orcid.org/0000-0002-7274-0177)
- Hironori Tanaka (ORCID: https://orcid.org/0000-0001-7795-3844)
- Osamu Yoshida
- Taeang Arai
- Soo Ki Kim (ORCID: https://orcid.org/0000-0001-5527-6555)
- Shinichiro Nakamura
- On behalf of the RELPEC Group and HCC 48 Group
- Takumi Fukumoto
- Yoshihide Ueda
- Hironori Ochi
- Hiroki Nishikawa
- Jumpei Okamura
- Shohei Komatsu
Publication Details
- Journal
- Oncology
- Published
- 2026-08-03
- DOI
- https://doi.org/10.1159/000553349
- Primary Topic
- Hepatocellular Carcinoma Treatment and Prognosis
- Type
- article
- Field-Weighted Citation Impact
- 0.00