Research Papers:

Non-secretion of AFP and neutrophil lymphocyte ratio as predictors for survival in hepatocellular carcinoma patients treated with sorafenib: a large UK cohort

Mehran Afshar, Peter Fletcher, Antonio D. Bardoli, Yuk Ting Ma and Pankaj Punia _

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Oncotarget. 2018; 9:16988-16995. https://doi.org/10.18632/oncotarget.24769

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Mehran Afshar1, Peter Fletcher2, Antonio D Bardoli3, Yuk Ting Ma4,* and Pankaj Punia5,*

1Oncology, St George’s University Hospitals NHS Foundation Trust, London, UK

2Cancer Research UK Clinical Trials Unit, Birmingham, UK

3College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

4Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK

5Oncology, Queen Elizabeth Hospital Birmingham, Birmingham, UK

*These authors contributed equally to this work

Correspondence to:

Pankaj Punia, email: Pankaj.Punia@uhb.nhs.uk

Keywords: neutrophil lymphocyte ratio (NLR); alpha-fetoprotein (AFP); hepatocellular carcinoma; sorafenib; survival

Received: July 31, 2017     Accepted: February 27, 2018     Published: March 30, 2018


Background: Sorafenib is the current standard of care for patients with advanced or metastatic hepatocellular carcinoma. Currently no universally agreed model exists correlating the Neutrophil Lymphocyte ratio (NLR) and non-secretion of AFP with the survival of HCC patients treated with sorafenib.

Patients and Methods: We retrospectively analysed patient records with a confirmed diagnosis of HCC treated with sorafenib between April 2009 and March 2014. Survival analysis was performed using the Kaplan–Meier method and Cox regression.

Results: Patients separated into groups based on NLR (≤3 or >3), or AFP secretion profile (<7 ng/ml or ≥7 ng/ml) derived diverging Kaplan–Meier curves for overall survival (OS). The median OS in those with NLR ≤3.0 was 9.0 months (95% CI: 7.7–11.1 months) and in those with NLR >3.0 it was 6.0 months (95% CI: 4.9–8.2 months) [HR 1.32 (95% CI: 0.96–1.80)]. The median overall survival post sorafenib was higher in the “non-secretor” AFP group. OS for AFP <7 ng/ml was 10.0 months (95% CI: 7.7–19.3 months) compared to AFP ≥7ng/ml: 6.6 months (95% CI: 5.3–8.4 months) [HR 1.64 (95% CI: 1.15–2.33)].

Conclusion: NLR and AFP non - secretion at diagnosis are potential significant prognosticators for overall survival from initiation of sorafenib.

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