Immunological inflammatory biomarkers as prognostic predictors for advanced hepatocellular carcinoma.

BACKGROUND: The immunological inflammatory biomarkers for advanced hepatocellular carcinoma are unclear. We aimed to investigate the association of immunity and inflammatory status with treatment outcomes in patients with advanced hepatocellular carcinoma who received molecular-targeted agents as primary treatment. PATIENTS AND METHODS: We enrolled 728 consecutive patients with advanced hepatocellular carcinoma who received sorafenib (n = 554) or lenvatinib (n = 174) as primary treatment in Japan between May 2009 and June 2020. Changes in the neutrophil-to-lymphocyte ratio before and 1 month after treatment and their impact on survival were evaluated. The cut-off values of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio for predicting overall and progression-free survival were calculated using receiver operating characteristic curves. RESULTS: The neutrophil-to-lymphocyte ratio, but not the platelet-to-lymphocyte ratio, was an independent prognostic factor. Patients with decreased neutrophil-to-lymphocyte ratio survived significantly longer than patients with increased neutrophil-to-lymphocyte ratio (median overall survival: 14.7 versus 10.4 months, P = 0.0110). Among patients with a low pre-treatment neutrophil-to-lymphocyte ratio, the overall survival did not differ significantly between those with decreased and those with increased neutrophil-to-lymphocyte ratio after 1 month (median: 19.0 versus 14.8 months, P = 0.1498). However, among patients with high pre-treatment neutrophil-to-lymphocyte ratio, those whose neutrophil-to-lymphocyte ratio decreased after 1 month showed significantly longer survival than those whose neutrophil-to-lymphocyte ratio increased (median: 12.7 versus 5.5 months, P < 0.0001). The therapeutic effect was not correlated with pre-treatment neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio. CONCLUSIONS: The neutrophil-to-lymphocyte ratio is a prognostic factor, along with liver function and tumor markers, in patients with advanced hepatocellular carcinoma who received molecular-targeted agents as primary treatment. Thus, the neutrophil-to-lymphocyte ratio could be a prognostic biomarker for advanced hepatocellular carcinoma primarily treated with immunotherapy.

[Application of the thermoelastic stress imaging method to prosthodontics. (2) Basic study of the stress field of artificial molar teeth, in which the existence of saliva was considered].

A basic study was conducted utilizing a thermoelastic stress imaging method for stress analysis of model of simplified artificial molars based on an interocclusal contact relationship. This involved examining the effect of artificial saliva application on a stress field in a situation where occlusal pressure was applied in a dynamic sliding movement. As a result, the following conclusions were obtained. 1. The thermoelastic stress imaging method allowed the stress field to be determined artificial saliva application at distributed load due to plane contact in dynamic sliding movement. 2. Compared with the case of non-saliva application, in a squaremodel having a sliding movement and to which artificial saliva was applied, the pattern of the high compressive stress area was found to be a circle or an ellipsoid. This showed a slight dispersion trend at 10 degrees, with the contact plane as the boundary, and the dispersion of stress concentration began to become clearer at 20; stress concentration on the contact plane tended to disappear at 30 degrees, and sliding was conspicuous and determination impossible at 45 degrees. 3. Results showed that 10 degrees was a transition angle at which a different aspect was shown, representing a trend in a stress field pattern change accompanying an increase in the facet bevel angle when artificial saliva was applied. 4. From the results of stress analysis using the square-shape sliding movement model to which artificial saliva was applied, 10 degrees to 20 degrees of facet bevel of artificial molars was considered preferable in consideration of the presence of saliva.