Abstract
The neutrophil to lymphocyte ratio (NLR), a simple marker of inflammation, has recently been showed to predict tumor recurrence in hepatocellular carcinoma (HCC) patients after hepatic resection or liver transplantation. However, whether it can be used to predict HCC development in cirrhotic patients remained unknown. The aim of this study was to evaluate the predictive value of the preoperative NLR for the development of HCC in cirrhotic patients who underwent splenectomy. A total of 230 HBV-associated cirrhotic patients who underwent splenectomy in our hospital from January 2000 to December 2012 were included in this study. Detailed clinical data included patients’ general characteristics, laboratory tests and imaging studies, surgical procedures and complications. Information on patients’ follow-up data was also obtained. We found that 38 (16.52%) patients developed HCC after splenectomy during the follow-up period. An elevated preoperative NLR was associated with increased risk of developing HCC in cirrhotic patients after splenectomy. The optimal cutoff value of NLR for HCC development was 2.27. In patients who developed HCC during the follow-up period, NLR scores showed no predictive value in overall survival after splenectomy. However, NLR scores appeared to have a much better predictive value in overall survival in patients who did not develop HCC. In conclusion, cirrhotic patients who underwent splenectomy remain at a relatively high risk of developing HCC, and an elevated preoperative NLR is associated with HCC development in cirrhotic patients who underwent splenectomy for hypersplenism.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world
The main purpose of this study, was to determine whether an elevated neutrophil to lymphocyte ratio (NLR) is associated with HCC development in cirrhotic patients who underwent splenectomy for hypersplenism, and if so, to determine the optimal predictive NLR cutoff value
The annual incidence of HCC in cirrhotic patients ranges from 0.04% to 6.3%[16,17,18,19,20,21]
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world. A recent study has shown that hypersplenism is positively correlated with the increased risk of HCC in patients with post-hepatitis cirrhosis[3]. Many cirrhotic patients who underwent splenectomy still developed HCC. The development of HCC is closely associated with inflammation status and immune responses[5]. NLR has been used to predict tumor recurrence in HCC patients after hepatic resection[13] or liver transplantation[14]. There are no published data assessing the role of NLR in predicting HCC development in cirrhotic patients after splenectomy. The main purpose of this study, was to determine whether an elevated NLR is associated with HCC development in cirrhotic patients who underwent splenectomy for hypersplenism, and if so, to determine the optimal predictive NLR cutoff value. Since the majority of cirrhotic patients in China have history of HBV infection, we focused on HBV-associated cirrhotic patients in the current study
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