S. M. McDermott1, N. Saunders3, E. M. Schneider2, D. Strosberg2, J. Onesti4, G. Davidson2, M. Bloomston5, M. Dillhoff2, C. R. Schmidt2, L. A. Shirley2 1Ohio State University,College Of Medicine,Columbus, OH, USA 2Ohio State University,Department Of Surgery,Columbus, OH, USA 3Emory University School Of Medicine,Department Of Surgery,Atlanta, GA, USA 4Mercy Health,Department Of Surgery,Grand Rapids, MI, USA 521st Century Oncology,Ft Myers, FL, USA
Introduction: The neutrophil to lymphocyte ratio (NLR) is predictive of outcomes in various cancers, including neuroendocrine tumors (NETs), as well as response to cancer related treatments, including transarterial chemoembolization (TACE). However, the role of NLR in patients with NET treated with TACE is incompletely understood. We hypothesized that, in patients with liver metastases from NETs, a lower NLR value pre-TACE, as well as post-procedure, would correlate with improved long-term outcomes.
Methods:
After IRB approval, we reviewed 262 patients who underwent TACE for metastatic NET at a single institution. NLR was calculated from the pre-TACE CBC drawn the day of the procedure and the post-TACE CBC drawn approximately one day, one week, and six months after initial treatment. NLR levels were then correlated with overall survival from the time of TACE.
Results:The median post-TACE survival of the entire cohort was 30.1 months. Mean NLR for patients who survived less than 3 years was 4.4 while the mean NLR for patients who survived more than 3 years was 3.3. Median overall survival of patients with a pre-TACE NLR < 4 was 33.3 months vs 21.1 months for patients with a pre-TACE NLR > 4 (p = 0.005). The median survival for patients with post-TACE NLR higher than pre-TACE NLR was 21.4 months vs 25.8 months for patients with post-TACE NLR less than or equal to pre-TACE NLR (p = 0.007) (Figure). NLR values from one day and one week post-TACE did not correlate with outcome.
Conclusion:
An elevated NLR pre-TACE, as well as an NLR value that has not returned to its pre-TACE value several months after the TACE, are associated with worse survival in patients with NET and liver metastases. This value can easily be calculated from the CBC routinely obtained from patients as part of their pre-procedural and post-procedural care. Calculating and trending NLR values for these patients may impact treatment strategies.
