Brief Article
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World J Gastroenterol. Dec 7, 2013; 19(45): 8398-8407
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8398
Neutrophil-lymphocyte ratio predicts the prognosis of patients with hepatocellular carcinoma after liver transplantation
Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan
Guang-Qin Xiao, Chang Liu, Da-Li Liu, Jia-Yin Yang, Lu-Nan Yan, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Xiao GQ and Yan LN conceived and designed the study; Xiao GQ, Liu C, Liu DL and Yang JY collected the data, followed the patients, analyzed the data and drafted the article; Yang JY and Yan LN revised the manuscript and obtained funding; Xiao GQ, Liu C, Liu DL, Yang JY, and Yan LN provided data acquisition and technical support and were involved in editing the manuscript.
Supported by The National Science and Technology Major Project of China, No. 2012ZX10002-016 and No. 2012ZX10002017-017
Correspondence to: Lu-Nan Yan, PhD, Department of Liver and Vascular Surgery, West China Hospital of Sichuan University, Wuhou District No. 37, Chengdu 610041, Sichuan Province, China. yanlunan1268@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: May 19, 2013
Revised: October 8, 2013
Accepted: November 3, 2013
Published online: December 7, 2013
Processing time: 213 Days and 10 Hours
Abstract

AIM: To determine whether an elevated neutrophil-lymphocyte ratio (NLR) is negatively associated with tumor recurrence in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after liver transplantation (LT), and to determine the optimal predictive NLR cut-off value.

METHODS: The data of HCC patients who had undergone LT came from the China Liver Transplant Registry database. We collected data from 326 liver cancer patients who had undergone LT at our medical center. We divided the patients into groups based on their NLRs (3, 4 or 5). We then compared the clinicopathological data and long-time survival between these groups. Meanwhile, we used receiver operating characteristic analysis to determine the optimal NLR cut-off.

RESULTS: Of 280 HCC patients included in this study, 263 were HBV positive. Patients with an NLR < 3 and patients with an NLR ≥ 3 but < 4 showed no significant differences in overall survival (OS) (P = 0.212) or disease-free survival (DFS) (P = 0.601). Patients with an NLR ≥ 4 but < 5 and patients with an NLR ≥ 5 also showed no significant differences in OS (P = 0.208) or DFS (P = 0.618). The 1-, 3- and 5-year OS rates of patients with an NLR < 4 vs an NLR ≥ 4 were 87.8%, 63.8% and 61.5% vs 73.9%, 36.7% and 30.3%, respectively (P < 0.001). The 1-, 3- and 5-year DFS rates of patients with an NLR < 4 vs NLR ≥ 4 were 83.9%, 62.9% and 60.7% vs 64.9%, 30.1% and 30.1%, respectively (P < 0.001). Univariate and multivariate analyses demonstrated that three factors, including NLR ≥ 4 (P = 0.002), were significant predictors of tumor recurrence in HCC patients after LT.

CONCLUSION: A preoperative elevated NLR significantly increased the risk for tumor recurrence in HCC patients after LT.

Keywords: Hepatocellular carcinoma; Liver transplantation; Inflammatory reaction; Neutrophil-lymphocyte ratio; Hepatitis B virus

Core tip: Inflammation has been linked to the biological characteristics of tumors. The neutrophil-lymphocyte ratio (NLR) is a simple biomarker of inflammation. Several studies have reported that a preoperative elevated NLR (in peripheral blood) is negatively associated with the prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). However, the ideal cut-off value is controversial, with studies citing both 3 and 5 as the appropriate cut-off NLR. In this study, we report 326 HCC patients who had undergone LT at our center. We identify NLR = 4 as the cut-off point for predicting the prognosis of HCC patients after LT.