Abstract
ObjectivesNeutrophil lymphocyte ratio (NLR) has been shown to predict prognosis of cancers in several studies. This study was designed to evaluate the impact of stratified NLR in patients who have received curative liver resection (CLR) for hepatocellular carcinoma (HCC).MethodsA total of 1659 patients who underwent CLR for suspected HCC between 2007 and 2014 were reviewed. The preoperative NLR was categorized into quartiles based on the quantity of the study population and the distribution of NLR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were significantly associated with overall survival (OS) and derived by Cox proportional hazard regression analyses. Univariate and multivariate Cox proportional hazard regression analyses were evaluated for association of all independent parameters with disease prognosis.ResultsMultivariable Cox proportional hazards models showed that the level of NLR (HR = 1.031, 95%CI: 1.002-1.060, P = 0.033), number of nodules (HR = 1.679, 95%CI: 1.285-2.194, P<0.001), portal vein thrombosis (HR = 4.329, 95%CI: 1.968-9.521, P<0.001), microvascular invasion (HR = 2.527, 95%CI: 1.726-3.700, P<0.001) and CTP score (HR = 1.675, 95%CI: 1.153-2.433, P = 0.007) were significant predictors of mortality. From the Kaplan-Meier analysis of overall survival (OS), each NLR quartile showed a progressively worse OS and apparent separation (log-rank P=0.008). The highest 5-year OS rate following CLR (60%) in HCC patients was observed in quartile 1. In contrast, the lowest 5-year OS rate (27%) was obtained in quartile 4.ConclusionsStratified NLR may predict significantly improved outcomes and strengthen the predictive power for patient responses to therapeutic intervention.
Highlights
Hepatocellular carcinoma (HCC) is the third most common cause of mortality in the world and at least300,000 of the 600,000 deaths worldwide occur in China alone [1]
Hazard ratios (HRs) and 95% confidence intervals (CIs) were significantly associated with overall survival (OS) and derived by Cox proportional hazard regression analyses
Multivariable Cox proportional hazards models showed that the level of neutrophil—lymphocyte ratio (NLR) (HR = 1.031, 95%CI: 1.002-1.060, P = 0.033), number of nodules (HR = 1.679, 95%CI: 1.285-2.194, P
Summary
Hepatocellular carcinoma (HCC) is the third most common cause of mortality in the world and at least300,000 of the 600,000 deaths worldwide occur in China alone [1]. Curative liver resection (CLR) provides a radical therapy in patients with early stages of the disease, but is associated with a high-risk of recurrence and a poor long-term prognosis [4,5,6]. It is necessary monitor patients for progression of HCC to reduce the recurrence rate and to prolong the survival period in HCC patients after CLR. Among patients with Hepato-pancreatico-biliary malignancy undergoing resection, elevated NLR is a predictor of worse long-term outcome [22]
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