Abstract
Background: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are immunonutritional indices, have been shown as an independent factor to predict postoperative recurrence and/or overall survival in patients with hepatocellular carcinoma (HCC). Aim: to validate neutrophils-to-lymphocytes ratio (NLR) as a predictor of post radiofrequency ablation recurrence of hepatocellular carcinoma (HCC). Patients and methods: This cross sectional prospective study was conducted on 50 Egyptian patients had radiofrequency ablation for HCC within Barcelona clinical liver cancer (BCLC) stage A. Pre-treatment laboratory tests and imaging were used to measure NLR, PLR, PNI, Child-Pugh (CTP score, tumor number and tumor size. HCC recurrences were followed after three month. Results: According to NLR cut-off value, the patients with NLR >1.73 had larger tumour size, and higher rates of tumor multiplicity .After 3 month follow up 30/50 (60%) patients had tumour recurrence. Regarding recurrence after RFA showed that CTP class B (P 11.74), NLR-PNI 1 group (NLR > 1.73 or PNI ≤ 11.74) and NLR-PNI 2 group (NLR > 1.73 and PNI ≤ 11.74). The patients with NLR-PNI 2 group had increase in number of portahepatis lymph node, number and size of tumor, decrease serum albumin and change in PNLR. Multivariate analyses suggested increased NLR (hazard ratio [HR] =2.09; 95% confidence interval [CI] =1.88–2.55; PConclusion: High blood NLR after RFA is a predictor for worse survival and also can predict recurrence of HCC. Higher NLR-PNI score predict a worse prognosis in patients who underwent RFA.
Highlights
Hepatocellular carcinoma (HCC) represents about 90% of primary liver cancers and is the sixth most frequent malignancy and the third most common cancer-related cause of death worldwide [1]
The diagnosis of HCC was carried out according to the American Association for the Study of Liver Diseases (AASLD) Practice Guidelines that proposed that one imaging technique (CT or MRI) showing the HCC radiological hallmark suffices for diagnosing tumors above 1cm in diameter in cirrhotic patients [11]
Among patients with post Radio Frequency Ablation (RFA) recurrence we assess the risk factors associated with recurrence as shown in Table 2, our result suggested that increase in number of Portahepatis LN, size and number of Tumour, increase in neutrophil to lymphocyte ratio (NLR) and change of platelet neutrophil–to–lymphocyte ratio (PNLR) after RFA, and decrease in prognostic nutritional index (PNI), lymphocyte count, platelet count and serum albumin were all potential impacts on recurrence
Summary
Hepatocellular carcinoma (HCC) represents about 90% of primary liver cancers and is the sixth most frequent malignancy and the third most common cancer-related cause of death worldwide [1]. In the treatment of hepatocellular carcinoma (HCC), fewer than 40% of patients are candidates for surgery, and the rate of recurrence after curative surgery is high [3]. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and prognostic nutritional index (PNI), are immunonutritional indices, have been shown as an independent factor to predict postoperative recurrence and/or overall survival in patients with hepatocellular carcinoma (HCC). Results: According to NLR cut-off value, the patients with NLR >1.73 had larger tumour size, and higher rates of tumor multiplicity .After 3 month follow up 30/50 (60%) patients had tumour recurrence. Regarding recurrence after RFA showed that CTP class B (P
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