Guo R, Gao M. Predictive value of neutrophil-lymphocyte ratio for prognosis in patients with advanced hepatocellular carcinoma treated with programmed cell death 1 inhibitors. World J Gastroenterol 2026; 32(18): 118416 [DOI: 10.3748/wjg.v32.i18.118416]
Corresponding Author of This Article
Rui Guo, Department of Laboratory Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Jinshui District, Zhengzhou 462000, Henan Province, China. guorui2460@163.com
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Oncology
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Retrospective Study
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May 14, 2026 (publication date) through May 6, 2026
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Guo R, Gao M. Predictive value of neutrophil-lymphocyte ratio for prognosis in patients with advanced hepatocellular carcinoma treated with programmed cell death 1 inhibitors. World J Gastroenterol 2026; 32(18): 118416 [DOI: 10.3748/wjg.v32.i18.118416]
World J Gastroenterol. May 14, 2026; 32(18): 118416 Published online May 14, 2026. doi: 10.3748/wjg.v32.i18.118416
Predictive value of neutrophil-lymphocyte ratio for prognosis in patients with advanced hepatocellular carcinoma treated with programmed cell death 1 inhibitors
Rui Guo, Meng Gao
Rui Guo, Department of Laboratory Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou 462000, Henan Province, China
Meng Gao, Department of Anesthesiology and Perioperative Medicine, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Author contributions: Guo R initiated research; Meng Gao designed the experiments and conducted clinical data collection, performed postoperative follow-up and recorded the data; Guo R conducted the collation and statistical analysis, and wrote the original manuscript and revised the paper; all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of Henan Provincial People's Hospital, No. 2024-1-112.
Informed consent statement: The ethics committee agrees to waive informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Corresponding author: Rui Guo, Department of Laboratory Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, No. 7 Weiwu Road, Jinshui District, Zhengzhou 462000, Henan Province, China. guorui2460@163.com
Received: January 9, 2026 Revised: January 30, 2026 Accepted: March 17, 2026 Published online: May 14, 2026 Processing time: 116 Days and 24 Hours
Abstract
BACKGROUND
The neutrophil-lymphocyte ratio (NLR) is an accessible inflammatory biomarker with emerging prognostic value in oncology.
AIM
To evaluate the predictive value of pretreatment NLR in patients with advanced hepatocellular carcinoma (aHCC) undergoing therapy with programmed cell death 1 (PD-1) inhibitors.
METHODS
This retrospective analysis included 234 patients with aHCC who received PD-1 inhibitor therapy between January 2022 and June 2024. The patients were categorized into good or poor prognosis groups according to overall survival relative to the median. The optimal NLR cutoff (3.165) was determined by receiver operator characteristic analysis, defining the low (≤ 3.165) and high (> 3.165) NLR groups. Hematological parameters were measured from blood samples collected within 1 week before treatment initiation. Radiologic assessments were conducted every 6-9 weeks in accordance with Response Evaluation Criteria in Solid Tumors v1.1. Progression-free survival (PFS) and overall survival (OS) were assessed during follow-up.
RESULTS
The high NLR group had significantly worse tumor burden and more advanced disease compared with the low NLR group. Multivariate analysis identified high NLR as an independent risk factor for poor prognosis (odds ratio = 4.365, P < 0.001) with the highest predictive accuracy (area under the curve = 0.785). The low NLR group demonstrated superior objective response rate (35.66% vs 16.19%, P = 0.001) and disease control rate (71.32% vs 57.14%, P = 0.024) and had significantly longer median progression-free survival (7.52 months vs 5.21 months, P < 0.001) and overall survival (16.84 months vs 11.05 months, P < 0.001). Cox regression confirmed that high NLR independently predicted poor PFS (hazard ratio = 2.084) and OS (hazard ratio = 2.421).
CONCLUSION
Pretreatment NLR is a powerful, independent prognostic biomarker for patients with aHCC receiving PD-1 inhibitor treatment.
Core Tip: This study demonstrates that a high pretreatment neutrophil-lymphocyte ratio (NLR) is an independent predictor of poor response and survival in advanced hepatocellular carcinoma patients treated with programmed cell death 1 inhibitors. NLR reflects a systemic inflammatory state that may undermine immunotherapy efficacy. Our findings support the use of this simple, cost-effective biomarker for risk stratification and treatment personalization in the immunotherapy era.
