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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Prognostic value of the neutrophil-to-lymphocyte ratio for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis
Shao-Hua Li, Qiao-Xuan Wang, Zhong-Yuan Yang, Wu Jiang, Cong Li, Peng Sun, Wei Wei, Ming Shi, Rong-Ping Guo
Shao-Hua Li, Qiao-Xuan Wang, Zhong-Yuan Yang, Wu Jiang, Cong Li, Peng Sun, Wei Wei, Ming Shi, Rong-Ping Guo, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Cancer Center of Sun Yat-Sen University, Guangzhou 510060, Guangdong Province, China
Shao-Hua Li, Wei Wei, Ming Shi, Rong-Ping Guo, Department of Hepatobiliary Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou 510275, Guangdong Province, China
Qiao-Xuan Wang, Department of Radiation Oncology, Cancer Center of Sun Yat-Sen University, Guangzhou 510275, Guangdong Province, China
Zhong-Yuan Yang, Department of Head and Neck Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou 510275, Guangdong Province, China
Wu Jiang, Cong Li, Department of Colorectal Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou 510275, Guangdong Province, China
Peng Sun, Department of Anesthesia, Cancer Center of Sun Yat-Sen University, Guangzhou 510275, Guangdong Province, China
Author contributions: Li SH and Wang QX contributed equally to this work; Li SH, Shi M, and Guo RP conceived and designed the experiments; Li SH, Wang QX, Yang ZY, Sun P, and Wei W performed the experiments; Li SH, Wang QX, Jiang W, and Li C analyzed the data; Li SH, Wang QX, and Yang ZY contributed reagents/materials/analysis tools; Li SH and Wang QX wrote the paper; all authors have read and approved the final version to be published.
Institutional review board statement: This research was approved by the Institutional Review Board of Sun Yat-Sen University Cancer Center. The methods were carried out in accordance with the approved guidelines.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by verbal consent. Individuals cannot be identified based on the data presented.
Conflict-of-interest statement: The authors have declared that no conflicts of interest exist.
Data sharing statement: The data are available from the Sun Yat-Sun University Cancer Center Institutional Data Access/Ethics Committee for researchers who meet the criteria for access to the confidential data. Address: Sun Yat-Sun University Cancer Center Institutional Data Access, 651 Dongfeng East Road, Guangzhou 510060, China. sfz@sysucc.org.cn.
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: Rong-Ping Guo, MD, Department of Hepatobiliary Surgery, Cancer Center of Sun Yat-Sen University, 651 Dongfeng East Road, Guangzhou 510275, Guangdong Province, China. guorp@sysucc.org.cn
Telephone: +86-20-87343115
Received: October 13, 2016
Peer-review started: October 14, 2016
First decision: December 28, 2016
Revised: January 16, 2017
Accepted: February 17, 2017
Article in press: February 17, 2017
Published online: May 7, 2017
AIM
To investigate whether the preoperative neutrophil-to-lymphocyte ratio (NLR) could predict the prognosis of hepatocellular carcinoma (HCC) patients with portal/hepatic vein tumor thrombosis (PVTT/HVTT) after hepatectomy.
METHODS
The study population included 81 HCC patients who underwent hepatectomy and were diagnosed with PVTT/HVTT based on pathological examination. The demographics, laboratory analyses, and histopathology data were analyzed.
RESULTS
Overall survival (OS) and disease-free survival (DFS) were determined in the patients with a high (> 2.9) and low (≤ 2.9) NLR. The median OS and DFS duration in the high NLR group were significantly shorter than those in the low NLR group (OS: 6.2 mo vs 15.7 mo, respectively, P = 0.007; DFS: 2.2 mo vs 3.7 mo, respectively, P = 0.039). An NLR > 2.9 was identified as an independent predictor of a poor prognosis of OS (P = 0.034, HR = 1.866; 95%CI: 1.048-3.322) in uni- and multivariate analyses. Moreover, there was a significantly positive correlation between the NLR and the Child-Pugh score (r = 0.276, P = 0.015) and the maximum diameter of the tumor (r = 0.435, P < 0.001). Additionally, the NLR could enhance the prognostic predictive power of the CLIP score for DFS in these patients.
CONCLUSION
The preoperative NLR is a prognostic predictor after hepatectomy for HCC patients with PVTT/HVTT. NLR > 2.9 indicates poorer OS and DFS.
Core tip: The systemic inflammatory response generated by tumors has been shown to cause the upregulation of cytokines and inflammatory mediators, leading to the promotion of angiogenesis and DNA damage and the inhibition of apoptosis. The presence of a systemic inflammatory response can be detected by the elevation of the neutrophil-to-lymphocyte ratio (NLR), which has been shown to be associated with poorer prognosis in patients with various types of malignant tumors. Our findings confirm that the NLR can be used as a potential prognostic predictor for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis after resection. The results of the present study may help identify a new serum marker for predicting the post-operation survival of these patients.
