Predictive analysis of NLR and TNF-α level for the efficacy of TACE combined with microwave ablation therapy in patients with massive liver cancer

Abstract

Abstract:

ObjectiveTo explore the predictive value of neutrophil-to-lymphocyte ratio （NLR） and tumor necrosis factor -α （TNF-α） level on the therapeutic effect of transcatheter arterial chemoembolization （TACE） combined with microwave ablation in patients with massive liver cancer.MethodsThe medical records of 106 patients with massive liver cancer who underwent TACE combined with microwave ablation treatment in the Affiliated Hospital of Weifang Medical University from February 2020 to February 2023 were retrospectively analyzed. The efficacy was evaluated 6 weeks after surgery， and the patients were divided into remission group and non-remission group according to the therapeutic effect. The levels of NLR and TNF-α in the two groups were detected before surgery， 3 days after surgery and 7 days after surgery. Point two column correlation was used to analyze the relationship between the levels of NLR and TNF-α in different time periods and the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer. The receiver operator characteristic （ROC） curve was drawn to analyze the predictive value of NLR and TNF-α levels in different time periods for the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer.ResultsSix weeks after surgery， out of 106 patients with massive liver cancer， 13 achieved complete remission， 48 achieved partial remission， 20 experienced disease progression， and 25 remained stable. The overall remission rate was 57.55% （61/106）. Before surgery， the levels of NLR [（2.26±0.13）vs.（2.43±0.12），t=6.87，P<0.001] and TNF-α [（36.20±4.38） pg/mlvs.（42.74±5.74） pg/ml，t=6.66，P<0.001] in the remission group （n=61） were lower than those in the non-remission group （n=45）， with statistically significant differences. At 3 days after surgery， there were no statistically significant difference in the levels of NLR [（6.16±3.22）vs.（6.22±3.30），t=0.09，P=0.925] or TNF-α [（48.84±7.22） pg/mlvs.（49.13±7.34） pg/ml，t=0.20，P=0.840] between the remission group and the non-remission group. At 7 days after surgery， the levels of NLR [（2.60±0.18）vs.（2.82±0.26），t=5.15，P<0.001] and TNF-α [（38.20±6.30） pg/mlvs.（45.57±5.79） pg/ml，t=6.16，P<0.001] in the remission group were lower than those in the non-remission group， with statistically significant differences. There were statistically significant differences in NLR and TNF-α levels before surgery， 3 days and 7 days after surgery between the remission group and the non-remission group （F=82.43，P<0.001；F=54.45，P<0.001；F=76.23，P<0.001；F=15.61，P<0.001）. Further pair-to-pair comparison showed that the levels of NLR and TNF-α were higher in both groups 3 and 7 days after surgery than before surgery， but the levels of NLR and TNF-α were lower in both groups 7 days after surgery than 3 days after surgery， with statistically significant differences （allP<0.005）. Point two column correlation analysis showed that NLR level， TNF-α level and the efficacy of TACE combined with microwave ablation in patients with massive liver cancer were significantly positively correlated before and 7 days after surgery （r=0.42，P<0.001；r=0.49，P<0.001；r=0.43，P<0.001；r=0.46，P<0.001）. ROC curve showed that the area under the curve （AUC） of NLR and TNF-α alone in predicting the efficacy of TACE combined with microwave ablation in patients with massive liver cancer before and 7 days after surgery was 0.750 （95%CI： 0.656-0.844）， 0.788 （95%CI： 0.699-0.877）， 0.751 （95%CI： 0.652-0.850）， 0.788 （95%CI： 0.700-0.876）， respectively. The AUC of combined prediction of NLR and TNF-α before and 7 days after surgery were 0.818 （95%CI： 0.736-0.900） and 0.813 （95%CI： 0.730-0.897）， respectively. There were no statistically significant differences in the AUC values of NLR and TNF-α alone or in combination for predicting the therapeutic effect of TACE combined with microwave ablation in patients with massive liver cancer before and 7 days after surgery （allP>0.05）.ConclusionsThe levels of NLR and TNF-α before and 7 days after surgery are related to the effect of TACE combined with microwave ablation in patients with massive liver cancer， and the combination of NLR and TNF-α levels before and 7 days after surgery has certain value in predicting the effect of TACE combined with microwave ablation in patients with massive liver cancer.

Key words:Liver neoplasms,Neutrophil-to-lymphocyte ratio,Tumor necrosis factor-alpha,Transcatheter arterial chemoembolization,Microwave ablation

Xing Hui, Tan Ying, Wang Xiuzhen, Li Rui, Liu Xia. Predictive analysis of NLR and TNF-α level for the efficacy of TACE combined with microwave ablation therapy in patients with massive liver cancer[J]. Journal of International Oncology, 2025, 52(2): 101-106.

Figures/Tables5

基线资料	缓解组（n=61）	未缓解组（n=45）	χ²/t值	P值
性别
男	42（68.85）	30（66.67）	0.06	0.812
女	19（31.15）	15（33.33）	0.06	0.812
年龄（岁）	52.68±5.24	53.08±5.13	0.39	0.696
肿瘤最大径（cm）	7.02±1.18	6.96±1.24	0.25	0.801
体质量指数（kg/m²）	23.02±2.34	22.85±2.16	0.38	0.703
Child-Pugh分级
A级	16（26.23）	13（28.89）	0.09	0.761
B级	45（73.77）	32（71.11）	0.09	0.761
BCLC分期
B期	20（32.79）	16（35.56）	0.09	0.766
C期	41（67.21）	29（64.44）	0.09	0.766
肿瘤数目
单发	52（85.25）	38（84.44）	0.01	0.909
多发	9（14.75）	7（15.56）	0.01	0.909
基础病因
乙型病毒性肝炎	43（70.49）	32（71.11）	0.01	0.945
丙型病毒性肝炎	18（29.51）	13（28.89）	0.01	0.945
白蛋白（g/L）	32.85±4.12	34.08±4.20	1.51	0.135
总胆红素（μmol/L）	15.90±5.68	15.24±5.92	0.58	0.563
ALT（U/L）	56.73±15.02	58.06±15.27	0.45	0.655
AST（U/L）	72.82±11.34	70.68±10.58	0.99	0.326
甲胎蛋白（μg/L）	435.46±42.33	430.89±46.02	0.53	0.598

时间	NLR		TNF-α（pg/ml）
术前	2.26±0.13	2.43±0.12	6.87	<0.001	36.20±4.38	42.74±5.74	6.66	<0.001
术后3 d	6.16±3.22^a	6.22±3.30^a	0.09	0.925	48.84±7.22^a	49.13±7.34^a	0.20	0.840
术后7 d	2.60±0.18^ab	2.82±0.26^ab	5.15	<0.001	38.20±6.30^ab	45.57±5.79^ab	6.16	<0.001
F值	82.43	54.45			76.23	15.61
P值	<0.001	<0.001			<0.001	<0.001

指标	r值	P值
术前
NLR	0.42	<0.001
TNF-α	0.49	<0.001
术后7 d
NLR	0.43	<0.001
TNF-α	0.46	<0.001

指标	AUC	95%CI	SE值	P值	最佳阈值	特异性	敏感性	约登指数
术前
NLR	0.750	0.656~0.844	0.048	<0.001	2.325	0.705	0.711	0.416
TNF-α	0.788	0.699~0.877	0.045	<0.001	37.945 pg/ml	0.623	0.800	0.423
联合	0.818	0.736~0.900	0.042	<0.001		0.721	0.778	0.499
术后7 d
NLR	0.751	0.652~0.850	0.051	<0.001	2.735	0.623	0.844	0.467
TNF-α	0.788	0.700~0.876	0.045	<0.001	40.210 pg/ml	0.787	0.689	0.476
联合	0.813	0.730~0.897	0.043	<0.001		0.738	0.778	0.513

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