Synchronous splenectomy and hepatectomy for patients with small hepatocellular carcinoma and pathological spleen: neutrophil to lymphocyte ratio changes can predict the prognosis.

Xiaoyun Zhang,Wentao Wang,Wei Peng,Jiayin Yang,Tianfu Wen,Chuan Li,Mingqing Xu,Lunan Yan,Yong Zeng,Bo Li

doi:10.18632/oncotarget.17758

Xiaoyun Zhang, Wentao Wang + Show 8 more

Open Access

https://doi.org/10.18632/oncotarget.17758

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Journal: Oncotarget	Publication Date: May 10, 2017
Citations: 18	License type: CC BY 3.0

Affiliation: West China Hospital of Sichuan University

Abstract

BackgroundTreatments about small hepatocellular carcinoma (HCC) and hypersplenism associated with good hepatic reserve are not well established. The aim of this study was to investigate the outcome of synchronous hepatectomy and splenectomy for those patients.Study DesignSplenomegaly and hypersplenism were defined as a pathological spleen. Seven hundred fifty-six patients with small HCC (381 with a pathological spleen, 375 without a pathological spleen) were divided into three groups. One hundred ten of 381 patients underwent synchronous hepatectomy and splenectomy (group A), 271 of 381 patients underwent hepatectomy alone (Group B) and 375 patients without pathological spleen underwent hepatectomy alone (Group C).The influence of pathological spleen, outcome of different treatments and systemic inflammatory response indexes were analyzed.ResultsBoth overall survival (OS, P=0.023) and disease-free survival (DFS, P=0.020) were significantly increased in group C compared to group B. A pathological spleen was a significant independent prognostic factor for OS and DFS among those two groups. In addition, OS (P=0.025) and DFS (P=0.004) were increased in the group A compared to group B. Splenectomy and neutrophil to lymphocyte ratio changes (ΔNLR) were significant independent prognostic factors of the prognosis for patients in groups A and B.ConclusionsA Pathological spleen influences the outcome of HCC patients. Synchronous hepatectomy and splenectomy should be performed among patients with small HCC and a pathological spleen. ΔNLR can predict the prognosis of these patients.

Highlights

Cirrhotic hypersplenism secondary to portal hypertension is commonly associated with hepatocellular carcinoma (HCC), resulting in anemia, leucopenia, and thrombocytopenia [1,2,3]
A Pathological spleen influences the outcome of HCC patients
Synchronous hepatectomy and splenectomy should be performed among patients with small HCC and a pathological spleen

Summary

Introduction

Cirrhotic hypersplenism secondary to portal hypertension is commonly associated with hepatocellular carcinoma (HCC), resulting in anemia, leucopenia, and thrombocytopenia [1,2,3]. Synchronous hepatectomy and splenectomy have been applied as another option to treat HCC and cirrhotic hypersplenism [5,6,7,8] especially in Japan and China. Many of these trials lacked adequate sample sizes and long-term followup and were heterogeneous with respect to the patient www.impactjournals.com/oncotarget populations, thereby limiting their ability to produce robust conclusions. Treatments about small hepatocellular carcinoma (HCC) and hypersplenism associated with good hepatic reserve are not well established. The aim of this study was to investigate the outcome of synchronous hepatectomy and splenectomy for those patients

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