Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1658
Peer-review started: March 10, 2018
First decision: March 29, 2018
Revised: April 2, 2018
Accepted: April 9, 2018
Article in press: April 9, 2018
Published online: April 21, 2018
Liver transplantation is the best curative therapy in case of hepatocellular cancer (HCC). However, it represents a scarce resource due to the reduced number of donors. Thus, a careful selection of HCC patients must be done preoperatively, with the intent to minimize the risk of futile transplants (i.e., post-operative cancer recurrence). As a consequence, new and easy-to-use predictors of recurrence are needed.
Recently, several biological aspects of HCC have been investigated, with the intent to identify scores aimed at improving the prediction of poor post-transplant outcomes. Among them, the inflammatory marker platelet-to-lymphocyte ratio (PLR) has been only marginally investigated, although it should represent a potentially excellent and cheap marker to use.
The main objective of the present study is to evaluate the role of PLR as a possible selection tool for the risk of HCC recurrence in the setting of liver transplantation.
A systematic review and a meta-analysis have been performed with the intent to evaluate the role of PLR. The PRISMA Guidelines have been used for performing the systematic research of studies focused on PLR, HCC and LT.
Five articles coming from Europe and Asia have been identified, with a total of 899 subjects investigated. At meta-analysis, high PLR value was associated with a significant increase in recurrence after transplantation (OR = 3.33; 95%CI: 1.78-6.25; P < 0.001).
A direct correlation between PLR values and tumor aggressiveness has been observed. High pre-transplant PLR values cause a 3.3-fold increased risk for post-transplant recurrence. Platelet-to-lymphocyte ratio is an easy and cheap value to use for selecting patients with hepatocellular cancer waiting for liver transplantation. PLR should be taken into account in the creation of new selection scores for HCC.
More studies aimed at better understanding biological and clinical mechanisms of the link between PLR and HCC are necessary.