Yeonjung Ha1,2,3, Mohamed A Mohamed Ali1, Molly M Petersen4, William S Harmsen4, Terry M Therneau4, Han Chu Lee2, Baek-Yeol Ryoo5, Sally Bampoh1, Kenneth A Valles1, Mohamad Mady1, Venkata R Missula1, Kritika Prasai1, Lewis R Roberts6, Kang Mo Kim7. 1. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. 2. Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. 3. Department of Gastroenterology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea. 4. Division of Biomedical Statistics and Informatics, Mayo Clinic Health Sciences Research, 205 Third Street SW, Rochester, MN, 55905, USA. 5. Department of Oncology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. 6. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. roberts.lewis@mayo.edu. 7. Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea. kimkm70@amc.seoul.kr.
Abstract
BACKGROUND: The ability of the pretreatment lymphocyte to monocyte ratio (LMR) to predict outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib is not conclusively determined. METHODS: We retrospectively studied patients treated with sorafenib for HCC in two tertiary referral centres in Asia and North America. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Predictive factors for the outcomes were determined by Cox proportional hazards models. A risk assessment tool was developed. RESULTS: Compared to the North America cohort, the Asia cohort was more heavily pretreated (72.1% vs. 35.2%; p < 0.001), had higher hepatitis B virus infection (87.6% vs. 5.6%; p < 0.001), and more distant metastases (83.2% vs. 25.4%; p < 0.001). Lower monocyte count in the Asia cohort (median 462.7 vs. 600.0/μL; p = 0.023) resulted in a higher LMR (median 2.6 vs. 1.8; p < 0.001). High LMR was associated with a significantly higher OS [hazard ratio (HR) 0.88; 95% confidence interval (CI) 0.81‒0.97; p = 0.007]. This was confirmed in a sensitivity analysis including patients treated in Asia only (HR 0.89; 95% CI 0.81‒0.97; p = 0.010). An OS nomogram was constructed with the following variables selected in the multivariate Cox model: LMR, treatment location, previous treatment, performance status, alpha-fetoprotein, lymph node metastasis, and Child‒Pugh score. The concordance score was 0.71 (95% CI, 0.67‒0.75). LMR did not predict PFS. CONCLUSION: LMR measured before sorafenib administration predicts OS in advanced HCC patients. Our OS nomogram, incorporating LMR, can be offered to clinicians to improve their ability to assess prognosis, strengthen the prognosis-based decision-making, and inform patients in the clinic.
BACKGROUND: The ability of the pretreatment lymphocyte to monocyte ratio (LMR) to predict outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib is not conclusively determined. METHODS: We retrospectively studied patients treated with sorafenib for HCC in two tertiary referral centres in Asia and North America. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Predictive factors for the outcomes were determined by Cox proportional hazards models. A risk assessment tool was developed. RESULTS: Compared to the North America cohort, the Asia cohort was more heavily pretreated (72.1% vs. 35.2%; p < 0.001), had higher hepatitis B virus infection (87.6% vs. 5.6%; p < 0.001), and more distant metastases (83.2% vs. 25.4%; p < 0.001). Lower monocyte count in the Asia cohort (median 462.7 vs. 600.0/μL; p = 0.023) resulted in a higher LMR (median 2.6 vs. 1.8; p < 0.001). High LMR was associated with a significantly higher OS [hazard ratio (HR) 0.88; 95% confidence interval (CI) 0.81‒0.97; p = 0.007]. This was confirmed in a sensitivity analysis including patients treated in Asia only (HR 0.89; 95% CI 0.81‒0.97; p = 0.010). An OS nomogram was constructed with the following variables selected in the multivariate Cox model: LMR, treatment location, previous treatment, performance status, alpha-fetoprotein, lymph node metastasis, and Child‒Pugh score. The concordance score was 0.71 (95% CI, 0.67‒0.75). LMR did not predict PFS. CONCLUSION:LMR measured before sorafenib administration predicts OS in advanced HCCpatients. Our OS nomogram, incorporating LMR, can be offered to clinicians to improve their ability to assess prognosis, strengthen the prognosis-based decision-making, and inform patients in the clinic.
Authors: Silke Appel; Anette Rupf; Markus M Weck; Oliver Schoor; Tim H Brümmendorf; Toni Weinschenk; Frank Grünebach; Peter Brossart Journal: Clin Cancer Res Date: 2005-03-01 Impact factor: 12.531
Authors: Ehsan Malek; Marcos de Lima; John J Letterio; Byung-Gyu Kim; James H Finke; James J Driscoll; Sergio A Giralt Journal: Blood Rev Date: 2016-04-12 Impact factor: 8.250
Authors: Josep M Llovet; Sergio Ricci; Vincenzo Mazzaferro; Philip Hilgard; Edward Gane; Jean-Frédéric Blanc; Andre Cosme de Oliveira; Armando Santoro; Jean-Luc Raoul; Alejandro Forner; Myron Schwartz; Camillo Porta; Stefan Zeuzem; Luigi Bolondi; Tim F Greten; Peter R Galle; Jean-François Seitz; Ivan Borbath; Dieter Häussinger; Tom Giannaris; Minghua Shan; Marius Moscovici; Dimitris Voliotis; Jordi Bruix Journal: N Engl J Med Date: 2008-07-24 Impact factor: 91.245
Authors: Ju Dong Yang; Essa A Mohamed; Ashraf O Abdel Aziz; Hend I Shousha; Mohamed B Hashem; Mohamed M Nabeel; Ahmed H Abdelmaksoud; Tamer M Elbaz; Mary Y Afihene; Babatunde M Duduyemi; Joshua P Ayawin; Adam Gyedu; Marie-Jeanne Lohouès-Kouacou; Antonin W Ndjitoyap Ndam; Ehab F Moustafa; Sahar M Hassany; Abdelmajeed M Moussa; Rose A Ugiagbe; Casimir E Omuemu; Richard Anthony; Dennis Palmer; Albert F Nyanga; Abraham O Malu; Solomon Obekpa; Abdelmounem E Abdo; Awatif I Siddig; Hatim M Y Mudawi; Uchenna Okonkwo; Mbang Kooffreh-Ada; Yaw A Awuku; Yvonne A Nartey; Elizabeth T Abbew; Nana A Awuku; Jesse A Otegbayo; Kolawole O Akande; Hailemichael M Desalegn; Abidemi E Omonisi; Akande O Ajayi; Edith N Okeke; Mary J Duguru; Pantong M Davwar; Michael C Okorie; Shettima Mustapha; Jose D Debes; Ponsiano Ocama; Olufunmilayo A Lesi; Emuobor Odeghe; Ruth Bello; Charles Onyekwere; Francis Ekere; Rufina Igetei; Mitchell A Mah'moud; Benyam Addissie; Hawa M Ali; Gregory J Gores; Mark D Topazian; Lewis R Roberts Journal: Lancet Gastroenterol Hepatol Date: 2016-12-03
Authors: Byung Su Kwon; Dae Hoon Jeong; Jung Mi Byun; Tae Hwa Lee; Kyung Un Choi; Yong Jung Song; Dong Soo Suh; Ki Hyung Kim Journal: J Cancer Date: 2018-03-08 Impact factor: 4.207
Authors: Mohamed Abdulwahab Mohamed Ali; William Scott Harmsen; Khairy Hammam Morsy; Ghada Moustapha Kamal Galal; Terry M Therneau; Lewis Rowland Roberts Journal: BMC Cancer Date: 2022-02-28 Impact factor: 4.430