Gastrointestinal
Postoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio predicts the outcomes of hepatocellular carcinoma

https://doi.org/10.1016/j.jss.2015.05.003Get rights and content

Abstract

Background

There is limited information regarding NLR-PLR (the combination of the neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) in hepatocellular carcinoma (HCC). This study aimed to assess the predictive ability of NLR-PLR in patients with resectable hepatitis B virus-related HCC within Milan criteria after hepatectomy.

Methods

Two hundred thirty-six consecutive HCC patients were included in the study. The postoperative NLR-PLR was calculated based on the data obtained on the first postoperative month after liver resection as follows: patients with both an elevated PLR and an elevated NLR, which were detected by receiver operating characteristic curve analysis, were allocated a score of 2, and patients showing one or neither of these elevations were allocated a score of 1 or 0, respectively.

Results

During the follow-up period, 113 patients experienced recurrence and 41 patients died. Multivariate analyses suggested that tumor-node-metastasis stage, preoperative alpha-fetal protein, and postoperative NLR-PLR were independently associated with recurrence, whereas microvascular invasion and postoperative NLR-PLR adversely impacted the overall survival. The 5-y recurrence-free and overall survival rates of the patients with a postoperative NLR-PLR of 0, 1, or 2 were 43.6%, 35.6%, or 8.3% (P < 0.001) and 82.1%, 73.0%, or 10.5% (P < 0.001), respectively.

Conclusions

The postoperative NLR-PLR predicted outcomes of hepatitis B virus-related HCC patients within Milan criteria after liver resection.

Introduction

Hepatocellular carcinoma (HCC) is the sixth most common cancer and third leading cause of cancer-related death worldwide [1]. Owing to the high prevalence of hepatitis B virus (HBV) infection, China alone accounts for approximately 55% of HCC cases globally [2]. Liver resection is perceived to be a curative treatment for some patients with HCC. However, the incidence of postoperative recurrence for patients with early stage HCC can be as high as 50%–70% after liver resection [3].

Several investigations have suggested that a patient's systemic inflammation response was associated with a patient's prognosis after liver resection, liver transplantation, transarterial chemoembolization, and hepatic arterial infusion chemotherapy [4], [5], [6], [7]. Previous investigations have proposed several inflammation-based scores to predict the outcomes of patients with HCC, such as the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) [6], [8]. However, the predictive power of NLR and PLR to predict the outcomes of patients with HCC after liver resection is under debate. For instance, Liao et al. [6] confirmed that high preoperative NLR was associated with poor recurrence-free survival (RFS) and overall survival (OS) of HCC after curative resection. However, Kinoshita et al. [9] suggested that NLR did not predict the outcomes of HCC. Recently, Parisi et al. [10] also confirmed that for HCC patients within Milan criteria, both preoperative NLR and PLR did not contribute to adverse outcomes after liver transplantation. Inflammation-based scores can reflect a patient's systemic inflammatory state, which could influence the prognosis of patients with HCC. Whether the combination of inflammation-based scores could better mirror the systemic inflammatory state is unclear. Accordingly, we investigate whether the combination of NLR and PLR is a useful predictor of the postoperative outcomes of HCC after liver resection. We carried out the present study to clarify this issue.

Section snippets

Study group

Patients with hepatitis B virus-related (HBV) HCC within Milan criteria who received liver resection between 2007 and 2014 at our center were included in this study. Hepatitis B surface antigen was detected in all patients. HCCs were confirmed by postoperative pathology. Patients with any one of following items were excluded from this study: (1) coinfection with hepatitis C virus; (2) simultaneous splenectomy; (3) ruptured HCC; (4) infections during the perioperative period; (5) reresection;

Results

A total of 236 qualified patients, including 207 males and 29 females, were enrolled in the present study. As presented in Table 1, the mean age was 49.98 ± 11.62 y. The mean tumor size was 3.28 ± 1.04 cm. Thirty-three patients had multiple tumors. A high preoperative AFP was observed in 74 patients. A positive HBV-DNA load was detected in 117 patients. Microvascular invasion (MVI) was detected in 44 patients. Capsular invasion was observed in 70 patients. The mean Ishak score of all patients

Discussion

Postoperative recurrence of HCC is a major barrier to achieving long-term survival for patients with HCC after liver resection. In this study, we confirmed that postoperative NLR-PLR is an independent risk factor for the outcomes of patients with resectable HBV-related HCC within Milan criteria after liver resection. In contrast to previous studies, our study emphasized the combination of postoperative NLR and PLR.

Many previous investigations have suggested that a high preoperative NLR was

Conclusions

In conclusion, our study suggested that postoperative NLR-PLR might be a surrogate marker for better stratification and management of HCC patients after liver resection. These results indicate that we should focus more on the change in a patient's postoperative systemic inflammatory state after liver resection.

Acknowledgment

This work was supported by grants from the National Science and Technology Major Project of China (2012ZX10002-016 and 2012ZX10002-017) as well as Scientific and Technological Support Project of Sichuan Province (2013SZ0032).

Authors' contributions: C.L. and T.F.W. proposed this study. C.L., L.N.Y., B.L., W.T.W., J.Y.Y., and M.Q.X. collected the data. C.L. analyzed the data.

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