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Abstract
Inflammatory markers have been studied in cancers and chronic states of inflammation. They are thought to correlate with tumor pathology through disruption of normal homeostasis. Markers such as neutrophil to lymphocyte ratio (NLR) among others have shown promise as prognostic tools in various cancers. In this study, we evaluate complete blood count based inflammatory markers in hepatocellular carcinoma (HCC) to predict overall and recurrence-free survival of patients after liver transplant. Between 2001 and 2017, all HCC indicated liver transplants were retrospectively reviewed. Inclusion criteria included presence of complete blood cell counts with differential within three months prior to transplantation. Exclusion criteria included retransplantation and inadequate posttransplant followup. A total of 160 patients with HCC were included in the study. Of those, 74.4% had hepatitis C virus as the underlying cause of HCC. Calculated Model for End stage Liver Disease (MELD) scores were statistically worse in patients with elevated NLR (≥5), derived NLR (≥3), and low lymphocyte to monocyte ratio (LMR) (<3.45), whereas elevated platelet to lymphocyte ratio (PLR) (≥150) did not correlate with MELD. Of the tumor characteristics, low LMR was associated with tumor presence and microvascular invasion on explant. Though overall survival trended towards better outcomes with low NLR and dNLR and high LMR, these did not reach statistical significance. High LMR also trended towards better recurrence-free survival without statistical significance. Low PLR was associated with statistically significant overall and recurrence-free survival. In conclusion, while prior studies in HCC have identified NLR as surrogate for tumor burden and survival, in this study we highlight that PLR is a good surrogate of mortality and recurrence-free survival in HCC transplant patients. Further, future study of PLR, NLR, and LMR in larger HCC populations before and after interventions may help clarify their clinical utility as a simple and noninvasive clinical tool as prognostic markers.
Highlights
Hepatocellular carcinoma (HCC) is the fourth leading cancer in mortality and the sixth most common cancer worldwide [1]
212 liver transplant (LT) were performed at our center for HCC
Model for End stage Liver Disease (MELD) scores were noted to be different based on the inflammatory surrogate markers
Summary
Hepatocellular carcinoma (HCC) is the fourth leading cancer in mortality and the sixth most common cancer worldwide [1]. According to the Scientific Registry of Transplant Recipients, there is a steady growth in liver transplant (LT) numbers with an annual 3% increase as of 2017 Of those on the wait list for LT, HCC is on the rise as an indication and accounts for nearly 10% of transplants in the same report [2]. HCC recurrence risk is perpetuated by the strong association with cirrhosis and the high vascular nature. This limits long term outcomes of localized treatment options such as resection and ablative therapy, and LT remains the cornerstone curative treatment in management of HCC [3, 4]. Despite the growth in LT numbers, donor supply is a restrictive factor and there is continued need to identify HCC patients who derive the major benefit from LT
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