Yonsei Med J.  2016 Sep;57(5):1115-1123. 10.3349/ymj.2016.57.5.1115.

Blood Neutrophil-to-Lymphocyte Ratio Predicts Tumor Recurrence in Patients with Hepatocellular Carcinoma within Milan Criteria after Hepatectomy

• Hu XG
• Mao W
• Park YK
• Xu WG
• Kim BW
• Wang HJ

• KMID: 2374155
• DOI: http://doi.org/10.3349/ymj.2016.57.5.1115

Abstract

PURPOSE
The systemic inflammation biomarker, Neutrophil-to-Lymphocyte Ratio (NLR), has been reported as one of the adverse prognostic factors for hepatocellular carcinoma (HCC) patient. The purpose of this study was to evaluate whether NLR could predict the risk of recurrence and death for the HCC patient, according to Milan criteria after hepatectomy.
MATERIALS AND METHODS
Retrospective analysis was performed on a database of HCC patients who underwent hepatectomy between March 2001 and December 2011. The cutoff value of NLR was decided by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate regression analyses were performed to identify predictive factors of recurrence and death.
RESULTS
A total of 213 patients were included in the present study. The median follow-up period was 48 months. One hundred and seven patients were experienced tumor recurrence; forty of them recurred within 12 months (early recurrence). NLR ≥1.505, albumin ≤3.75 g/dL, microvascular invasion and high grade of cirrhosis were found to be independent factors for adverse recurrence-free survival in multivariate regression analysis. And NLR ≥1.945 was also found as a prognosis factor for early recurrence by univariate regression analysis.
CONCLUSION
Elevated preoperative NLR can be easily obtained and reliable biomarker for assessing the tumor recurrence and early recurrence of Milan criteria HCC after the initial hepatectomy.

Keyword

Neutrophils; lymphocytes; prognosis; hepatocellular carcinoma; hepatectomy

MeSH Terms

Adult
Aged
Biomarkers
Biomarkers, Tumor/blood
Carcinoma, Hepatocellular/*surgery
Disease-Free Survival
Female
Follow-Up Studies
Hepatectomy
Humans
Liver Neoplasms/*surgery
Lymphocyte Count
*Lymphocytes
Male
Middle Aged
Neoplasm Recurrence, Local/*blood
*Neutrophils
ROC Curve
Retrospective Studies
Biomarkers
Biomarkers, Tumor

Figure

• 

  Fig. 1 Treatment methods for recurrence tumor after initial hepatectomy. RFA, radiofrequency ablation; RR, repear resection; SLT, salvage liver transplantation; TACE, transcatheter arterial chemoembolization.

• 

  Fig. 2 ROC curve to assess the optimal cutoff value of NLR for tumor recurrence (1.505) (A) and early recurrence (1.945) (B). AUC, area under the curve; ROC, receiver operating characteristic; NLR, Neutrophil-to-Lymphocyte Ratio.

• 

  Fig. 3 (A and B) Kaplan-Meier survival analysis the overall survival and recurrence free survival of the present study patients. (C and D) Kaplan-Meier survival analysis patients with NLR >1.505 have a shorter recurrence free survival time, however, there were no difference on overall survival. NLR, Neutrophil-Lymphocyte Ratio.

• 

  Fig. 4 Kaplan-Meier survival analysis shows that the patients who experience early recurrence have a significantly lower overall survival.

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