Non-secretion of AFP and neutrophil lymphocyte ratio as predictors for survival in hepatocellular carcinoma patients treated with sorafenib; A large UK cohort

Abstract

Background: Sorafenib is the current standard of care for patients with advanced or metastatic hepatocellular carcinoma. Currently no universally agreed model exists correlating the Neutrophil Lymphocyte ratio (NLR) and non-secretion of AFP with the survival of HCC patients treated with sorafenib. Patients and Methods: We retrospectively analysed patient records with a confirmed diagnosis of HCC treated with sorafenib between April 2009 and March 2014. Survival analysis was performed using the Kaplan-Meier method and Cox regression. Results: Patients separated into groups based on NLR (≤ 3 or > 3), or AFP secretion profile ( < 7 ng/ml or ≥7 ng/ml) derived diverging Kaplan-Meier curves for overall survival (OS). The median OS in those with NLR ≤ 3.0 was 9.0 months (95% CI: 7.7-11.1 months) and in those with NLR > 3.0 it was 6.0 months (95% CI: 4.9-8.2 months) [HR 1.32 (95% CI: 0.96-1.80)]. The median overall survival post sorafenib was higher in the "non-secretor" AFP group. OS for AFP < 7 ng/ml was 10.0 months (95% CI: 7.7-19.3 months) compared to AFP =7ng/ml: 6.6 months (95% CI: 5.3-8.4 months) [HR 1.64 (95% CI: 1.15-2.33)]. Conclusion: NLR and AFP non - secretion at diagnosis are potential significant prognosticators for overall survival from initiation of sorafenib.