Neutrophil-to-Apolipoprotein A1 Ratio Predicted Overall Survival in Hepatocellular Carcinoma receiving Transarterial Chemoembolization.

PURPOSE To investigate the predictive capability of Neutrophil-to-Apolipoprotein A1 ratio (NAR) for predicting overall survival (OS) among hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE). PATIENTS AND METHODS We investigated the clinical features of 554 HCC patients receiving TACE and assessed NAR's predictive value for OS with 222 consisting the discovery cohort and 332 consisting the validation cohort. The association of NAR with circulation LOX-1+ polymorphonuclear myeloid-derived suppressor cells (PMN-MDSC) were illustrated. RESULTS Multivariate Cox regression revealed lymphocyte count, TNM stage and NAR were independent prognostic factors in discovery cohort. Validation cohort confirmed the independent prognostic value of TNM stage and NAR. Patients with low NAR (<2.7) displayed significantly increased OS in the discovery cohort (59.8 months vs 21 months), validation group (38.0 months vs 23.6 months) and the total cohort (44.1 months vs 22.0 months). Then Cox proportional hazards model was conducted to combine Cancer of the Liver Italian Program (CLIP) score with discretized NAR. C-index illustrated that NAR integrated CLIP score was best model compared with NAR and CLIP score. Furthermore, NAR-CLIP presented superior predictive capacity for 10, 20, 30, 40, 50 and 60-month survival compared with CLIP by survival ROC analysis in the discovery cohort, validation cohort and total cohort. NAR was significantly associated with LOX-1+ PMN-MDSC by linear regression. CONCLUSION In summary, the present study identified NAR as an independent predictor for OS among HCC patients receiving TACE. NAR reflected circulation LOX-1+ PMN-MDSC level. IMPLICATIONS FOR PRACTICE The present study identified Neutrophil-to-Apolipoprotein A1 Ratio (NAR) as an independent predictor for overall survival among hepatocellular carcinoma patients receiving Transarterial Chemoembolization. NAR reflected circulation LOX-1+ PMN-MDSC level.