Purpose: The platelet to lymphocyte ratio (PLR) has been found to be valuable in predicting outcomes of hepatocellular carcinoma (HCC) patients undergoing locoregional therapies such as transarterial chemoembolization. However, more data is needed in regards to its relevancy in radioembolization. The purpose of this study was to determine the predictive value of PLR in terms of radiologic response and overall survival (OS) in hepatocellular carcinoma (HCC) patients undergoing radioembolization.
Materials and Methods: Between 1/1/2014 and 12/31/2019 a total of 158 patients who underwent radioembolization for HCC were evaluated. The patient’s record was evaluated for pre and post procedural laboratory values as well as radiologic response according to the European Association for the Study of the Liver (EASL) criteria. Overall radiologic response (ORR) was defined as those who showed a partial or complete response. Survival was measured from the initial radioembolization to time of death; patients were censored for transplant. Patients were placed into two cohorts utilizing a PLR of 140.
Results: The cohort included 43/158 (27.2%) women and 115/158 (72.8%) men with an average age of 58.4 ± 6.9 years. The mean PLR was 138.3 ± 119.7. When looking at ORR, there was a significant difference in the PLR in those who had an ORR (119.2 ± 93.9) and those who did not (170.3 ± 149) (p=0.004). While the OS for those with a PLR < 140 (1.03 ± 1 year) was longer than those with a PLR >140 (0.84 ± 0.44 years) it was not significantly longer (p=0.18). However, the OS was longer in those who had a decrease in PLR following treatment, when compared to those who had an increase (1.46 ± 1.03 vs 0.96 ± 0.82 years, p=0.04). Finally, while the percentage of patients who achieved an ORR in those with a decrease in PLR after radioembolization (24/26, 92.3%) was greater as compared to those who had an increase (75/98, 76.5%), it was not significantly so (p=0.07).
Conclusion: PLR may hold promise in predicting radiologic response and increasing PLR following radioembolization may portend a worse prognosis in patients undergoing radioembolization for HCC.