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.

Graphical Abstract

Multivariable analysis identified a high NLR (≥ 2.56) as an independent predictor of decreased overall survival (hazard ratio: 1.919). Spline curve analysis suggested that an NLR range of approximately 2.3–3.0 constitutes an optimal threshold for predicting overall survival.

Conflicts of Interest

Toshifumi Tada: lecture fees from AbbVie, Eisai, AstraZeneca, and Chugai. Atsushi Hiraoka: lecture fees from Eisai, Bayer, Eli Lilly, and Otsuka. Hidenori Toyoda: lecture fees from AbbVie, Eisai, Gilead Sciences, Terumo, and Bayer. Satoru Kakizaki: lecture fees from AbbVie. Masatoshi Kudo: advisory role at Eisai, Ono, MSD, Bristol Myers Squibb, and Roche; lecture fees from Eisai, Bayer, MSD, Bristol Myers Squibb, Eli Lilly, and EA Pharma; and research funding from Gilead Sciences, Taiho, Sumitomo Dainippon Pharma, Takeda, Otsuka, EA Pharma, AbbVie, and Eisai. Toshifumi Tada, Hidekatsu Kuroda, and Masaki Kaibori are editorial board members of Hepatology Research. None of the other authors have potential conflicts of interest to declare.

Open Research

Data Availability Statement

The datasets are available from the corresponding author upon reasonable request.

Supporting Information

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