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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Blood neutrophil-lymphocyte ratio predicts survival after hepatectomy for hepatocellular carcinoma: A propensity score-based analysis
Hao-Jie Yang, Zhe Guo, Yu-Ting Yang, Jing-Hang Jiang, Ya-Peng Qi, Ji-Jia Li, Le-Qun Li, Bang-De Xiang
Hao-Jie Yang, Ya-Peng Qi, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Hao-Jie Yang, Department of General Surgery, the First People’s Hospital of Changde, Changde 415000, Hunan Province, China
Yu-Ting Yang, Department of Oncology, the First People’s Hospital of Changde, Changde 415000, Hunan Province, China
Zhe Guo, Department of Thyroid and Breast Surgery, Central Hospital of Wuhan, Wuhan 430000, Hubei Province, China
Jing-Hang Jiang, Department of General Surgery, Second People’s Hospital of Jingmen, Jingmen 448000, Hubei Province, China
Ji-Jia Li, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Yang HJ, Guo Z and Yang YT contributed equally to this work; Xiang BD and Li LQ designed the research; Yang HJ, Guo Z, Yang YT and Qi YP performed the research; Yang HJ, Yang YT and Li JJ evaluated the clinic records and performed the statistical analyses; Yang HJ wrote the manuscript; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81260331; and the Key Laboratory for High-Incidence Tumor Prevention and Treatment, Ministry of Education, No. GKE2015-ZZ05.
Institutional review board statement: The study was reviewed and approved by the Tumor Hospital of Guangxi Medical University Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at cdsdyrmyy01@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bang-De Xiang, Professor, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. yhj894924067@163.com
Telephone: +86-771-5310045 Fax: +86-771-5312000
Received: February 2, 2016
Peer-review started: February 2, 2016
First decision: March 7, 2016
Revised: March 22, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: June 7, 2016
AIM: To investigate whether an elevated preoperative neutrophil-to-lymphocyte ratio (NLR) can predict poor survival in patients with hepatocellular carcinoma (HCC).
METHODS: We retrospectively reviewed 526 patients with HCC who underwent surgery between 2004 and 2011.
RESULTS: Preoperative NLR ≥ 2.81 was an independent predictor of poor disease-free survival (DFS, P < 0.001) and overall survival (OS, P = 0.044). Compared with patients who showed a preoperative NLR < 2.81 and postoperative increase, patients who showed preoperative NLR ≥ 2.81 and postoperative decrease had worse survival (DFS, P < 0.001; OS, P < 0.001). Among patients with preoperative NLR ≥ 2.81, survival was significantly higher among those showing a postoperative decrease in NLR than among those showing an increase (DFS, P < 0.001; OS, P < 0.001). When elevated, alpha-fetoprotein (AFP) provided no prognostic information, and so preoperative NLR ≥ 2.81 may be a good complementary indicator of poor OS whenever AFP levels are low or high.
CONCLUSION: Preoperative NLR ≥ 2.81 may be an indicator of poor DFS and OS in patients with HCC undergoing surgery. Preoperative NLR ≥ 2.81 may be a good complementary indicator of poor OS when elevated AFP levels provide no prognostic information.
Core tip: We retrospectively analyzed a relatively large cohort of patients and used propensity score matching to balance out biases related to patient selection. Our results suggest that preoperative neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of poor overall and disease-free survival. We further suggest that postoperative decrease in NLR is associated with poor survival, although only in patients with high preoperative NLR. Finally, we show that preoperative NLR ≥ 2.81 may be a good complementary indicator of poor overall survival when elevated alpha-fetoprotein levels provide no prognostic information.
