Prediction of pain intensity after transarterial chemoembolization in patients with hepatocellular carcinoma by neutrophil to lymphocyte ratio-platelet to lymphocyte ratio score

Abstract

Abstract: Objective: The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) was combined to construct a comprehensive inflammatory response score (named NLR-PLRs), followed by a nomogram model to predict the intensity of pain after transcatheter arterial chemoembolization (TACE).
Method: Totally 170 patients with unresectable hepatocellular carcinoma (HCC) treated in the Affiliated Hospital of Wanxi Health Vocational College operating room from January 2017 to December 2021 were selected. These patients were randomly divided into test set (n=102) and validation set (n=68) according to the ratio of 1.5:1. NLR-PLRs was constructed based on the receiver operator characteristic (ROC) curve analysis results for NLR and PLR predicting moderate or severe pain after TACE. Risk factors for moderate or severe pain after TACE were analyzed in the test set using multifactorial Logistic regression, and then a nomogram model was constructed. The predictive performance of the nomogram model was evaluated using test set and validation set data.
Result: In the test set, both NLR and PLR were higher in patients with moderate or severe pain after TACE than in patients with no or mild pain after TACE, and all differences were statistically significant (P<0.05). The ROC curves showed that the area under the curve (AUC) for NLR and PLR to predict moderate or severe pain after TACE was 0.700 and 0.764, with optimal cut-off values of 3.27 and 173.79, respectively. Age, maximum tumor diameter, number of tumors, portal venous tumor thrombus (PVTT), and NLR-PLRs were independent risk factors for moderate or severe pain after TACE (all P<0.05). In the test set, the consistency index (C-index) was 0.847 (95%CI: 0.738-0.911) and the AUC was 0.866 (95%CI: 0.784-0.925). The nomogram model provided a significant additional net clinical benefit over the individual predictor results. Similarly, C-index was 0.749 (95%CI: 0.629-0.847), and the AUC was 0.749 (95%CI: 0.629-0.847) in the validation set, while the nomogram model provided a significant additional net clinical benefit over the individual predictor results.
Conclusion: NLR-PLRs was associated with moderate or severe pain after TACE. The nomogram model based on NLR-PLRs may inform the timing of pain care management procedure initiation.

Key words: Hepatocellular carcinoma, Inflammation, Transarterial chemoembolization, Pain, Nomogram model

Liang Qianjing, Wu Deping, Wang Shengjie, Yan Kangming, Deng Lili, Han Shanshan. Prediction of pain intensity after transarterial chemoembolization in patients with hepatocellular carcinoma by neutrophil to lymphocyte ratio-platelet to lymphocyte ratio score[J]. Electronic Journal of Liver Tumor, 2022, 9(3): 27-35.

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