Background: Trans-arterial chemoembolization (TACE) is the most commonly used method to treat patients with large, un-resectable tumors or bridge therapy in patients with hepatocellular carcinoma (HCC) prior to liver transplantation. We evaluated the response to TACE treatment in patients with hepatocellular carcinoma according to modified RECIST criteria and determined the prognostic value of neutrophil-to-lymphocyte ratio (NLR). Methods: In this cross-sectional study, patients with definitive diagnosis of HCC referred for TACE were studied. The response rate to TACE treatment was assessed based on dynamic MRI 28-days after treatment according to modified RECIST criteria. The NLR value was calculated and its prognostic value was evaluated to predict the response to treatment. Results: Forty patients with HCC who underwent TACE were included in the study. The response to TACE treatment in included patients was: complete response (CR) in 6 patients (15%), partial response (PR) in 16 patients (40%) and stable disease (SD) in 18 patients (45%). No progressive disease (PD) was found. Responders (CR + PR) were 22 (55%) cases. The mean NLR after treatment in the non-responder group was significantly higher than the responder group (4.2 vs 2.4, P-value = 0.026). NLR values greater than 2.6 after treatment had a sensitivity of 70.6% and a specificity of 77.3% in the diagnosis of non-responders with an Area Under the Curve (AUC) of 0.73 [95% confidence interval 0.58 - 0.89], P-value = 0.011). Conclusion: Compared to responders, higher levels of NLR after treatment were observed in the non-responder group. NLR level more than 2.6 after treatment is believed to be able to discriminate non-responders as a moderate prognostication tool.

The authors have declared no competing interest.

This study did not receive any funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study has been approved by Tehran University of Medical Sciences ethics committee (IR.TUMS.IKHC.REC.1397.245).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All the material and data used in this manuscript can be provided through official request to the corresponding author.