Angelo Della Corte1,2,3, Claudio Sallemi4, Francesca Ratti5, Lorenzo Monfardini4, Simone Gusmini6, Federica Cipriani5, Renato Pennella6, Domenico Santangelo6, Valentina Burgio7, Andrea Casadei-Gardini8,7, Luca Aldrighetti8,5, Francesco De Cobelli6,9,8. 1. Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy. dellacorte.angelo@hsr.it. 2. Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy. dellacorte.angelo@hsr.it. 3. University Vita-Salute San Raffaele, 20132, Milan, Italy. dellacorte.angelo@hsr.it. 4. Radiology Department, Fondazione Poliambulanza Istituto Ospedaliero, 25124, Brescia, Italy. 5. Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy. 6. Department of Radiology, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy. 7. Unit of Oncology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy. 8. University Vita-Salute San Raffaele, 20132, Milan, Italy. 9. Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy.
Abstract
PURPOSE: Neutrophil-to-lymphocyte ratio (NLR) recently demonstrated predictive value for hepatocellular carcinoma (HCC) recurrence after thermal ablation. Microwave ablation (MWA) has been shown to induce changes in the immune landscape after HCC treatment. This study aims at identifying predictors of local tumor progression (LTP) and post-treatment NLR kinetics after MWA. MATERIALS AND METHODS: Data from 108 consecutive patients who underwent percutaneous MWA of 119 HCCs with a 2450 Hz/100 W generator in two institutions from October 2014 to September 2021 were retrospectively reviewed. Forty-five HCCs (42 patients) met inclusion criteria for analysis (technique efficacy, pre- and post-treatment NLR availability, follow-up > 6 months, absence of complications). NLR was analyzed prior to therapy and at 1-month follow-up; difference between the two time points was defined as ΔNLR1stFU. RESULTS: After a median follow-up of 25 months, LTP occurred in 18 HCCs (40%) and 18 patients (42.9%). Multivariate competing risk regression comprising ΔNLR1stFU > 0, cirrhosis etiology and subcapsular location showed that the only independent predictor of LTP was ΔNLR1stFU > 0, on both a per-patient (HR = 2.7, p = 0.049) and per-tumor (HR = 2.8, p = 0.047) analysis. ΔNLR1stFU > 0 occurred in 24/42 patients (57.1%). In this subgroup, higher rates of female patients (p = 0.026), higher mean baseline NLR (p < 0.0001) and lower mean energy/size (p = 0.006) were observed. Upon ROC curve analysis, energy/size < 1414 J/mm predicted ΔNLR1stFU > 0 with 76% sensitivity and 70% specificity (AUC = 0.74). CONCLUSION: NLR increase after ablation was the only independent predictor of LTP, supporting the role of balance between systemic inflammation and immunity in recurrence after MWA. Ablation energy/tumor size predicted NLR increase, reinforcing the concept of immune ablation. LEVEL OF EVIDENCE: III.
PURPOSE: Neutrophil-to-lymphocyte ratio (NLR) recently demonstrated predictive value for hepatocellular carcinoma (HCC) recurrence after thermal ablation. Microwave ablation (MWA) has been shown to induce changes in the immune landscape after HCC treatment. This study aims at identifying predictors of local tumor progression (LTP) and post-treatment NLR kinetics after MWA. MATERIALS AND METHODS: Data from 108 consecutive patients who underwent percutaneous MWA of 119 HCCs with a 2450 Hz/100 W generator in two institutions from October 2014 to September 2021 were retrospectively reviewed. Forty-five HCCs (42 patients) met inclusion criteria for analysis (technique efficacy, pre- and post-treatment NLR availability, follow-up > 6 months, absence of complications). NLR was analyzed prior to therapy and at 1-month follow-up; difference between the two time points was defined as ΔNLR1stFU. RESULTS: After a median follow-up of 25 months, LTP occurred in 18 HCCs (40%) and 18 patients (42.9%). Multivariate competing risk regression comprising ΔNLR1stFU > 0, cirrhosis etiology and subcapsular location showed that the only independent predictor of LTP was ΔNLR1stFU > 0, on both a per-patient (HR = 2.7, p = 0.049) and per-tumor (HR = 2.8, p = 0.047) analysis. ΔNLR1stFU > 0 occurred in 24/42 patients (57.1%). In this subgroup, higher rates of female patients (p = 0.026), higher mean baseline NLR (p < 0.0001) and lower mean energy/size (p = 0.006) were observed. Upon ROC curve analysis, energy/size < 1414 J/mm predicted ΔNLR1stFU > 0 with 76% sensitivity and 70% specificity (AUC = 0.74). CONCLUSION: NLR increase after ablation was the only independent predictor of LTP, supporting the role of balance between systemic inflammation and immunity in recurrence after MWA. Ablation energy/tumor size predicted NLR increase, reinforcing the concept of immune ablation. LEVEL OF EVIDENCE: III.
Authors: S Di Sandro; L Benuzzi; A Lauterio; F Botta; R De Carlis; M Najjar; L Centonze; M Danieli; I Pezzoli; A Rampoldi; V Bagnardi; L De Carlis Journal: Eur J Surg Oncol Date: 2019-04-29 Impact factor: 4.424
Authors: Miral Sadaria Grandhi; Amy K Kim; Sean M Ronnekleiv-Kelly; Ihab R Kamel; Mounes A Ghasebeh; Timothy M Pawlik Journal: Surg Oncol Date: 2016-03-05 Impact factor: 3.279