Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2020; 26(33): 5022-5049
Published online Sep 7, 2020. doi: 10.3748/wjg.v26.i33.5022
Neutrophil to lymphocyte ratio and albumin bilirubin grade in hepatocellular carcinoma: A systematic review
Ayman Bannaga, Ramesh P Arasaradnam
Ayman Bannaga, Ramesh P Arasaradnam, Department of Gastroenterology and Hepatology, University Hospital Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, West Midlands, United Kingdom
Ayman Bannaga, Ramesh P Arasaradnam, Warwick Medical School, University of Warwick, Coventry CV4 7HL, West Midlands, United Kingdom
Author contributions: Bannaga A was involved in the design, data curation, data analysis, and generating the first draft; Arasaradnam RP supervised the project and edited the draft for intellectual input.
Conflict-of-interest statement: Authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Ayman Bannaga, MBBS, MRCP, Research Fellow, Department of Gastroenterology and Hepatology, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, West Midlands, United Kingdom. aymanbannaga@yahoo.com
Received: June 26, 2020
Peer-review started: June 26, 2020
First decision: July 28, 2020
Revised: August 10, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: September 7, 2020
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging prognostic indicators in HCC.

AIM

To study published literature of NLR and ALBI over the last five years, and to validate NLR and ALBI locally in our centre as indicators of HCC survival.

METHODS

A systematic review of the published literature on PubMed of NLR and ALBI in HCC over the last five years. The search followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses. Additionally, we also investigated HCC cases between December 2013 and December 2018 in our centre.

RESULTS

There were 54 studies describing the relation between HCC and NLR and 95 studies describing the relation between HCC and ALBI grade over the last five years. Our local cohort of patients showed NLR to have a significant negative relationship to survival (P = 0.011). There was also significant inverse relationship between the size of the largest HCC nodule and survival (P = 0.009). Median survival with alpha fetoprotein (AFP) < 10 KU/L was 20 mo and with AFP > 10 KU/L was 5 mo. We found that AFP was inversely related to survival, this relationship was not statically significant (P = 0.132). Mean survival for ALBI grade 1 was 37.7 mo, ALBI grade 2 was 13.4 months and ALBI grade 3 was 4.5 mo. ALBI grades performed better than Child Turcotte Pugh score in detecting death from HCC.

CONCLUSION

NLR and ALBI grade in HCC predict survival better than the conventional alpha fetoprotein. ALBI grade performs better than Child Turcotte Pugh score. These markers are done as part of routine clinical care and in cases of normal alpha fetoprotein, these markers could give a better understanding of the patient disease progression. NLR and ALBI grade could have a role in modified easier to learn staging and prognostic systems for HCC.

Keywords: Hepatocellular carcinoma, Albumin bilirubin Grade, Neutrophil to lymphocyte ratio, Alpha fetoprotein, Prognosis, Survival

Core tip: This review examined the current evidence over the last five years concerning the use of neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) as prognostic indicators in Hepatocellular carcinoma (HCC) from a clinical point of view. We also validated NLR and ALBI as prognostic indicators for HCC in a small cohort of patients in our centre. NLR and ALBI provide ways to prognosticate for HCC patients and should be used in addition to other conventional methods to aid in clinical judgment.