Clin Mol Hepatol.  2019 Sep;25(3):305-316. 10.3350/cmh.2019.0004.

Underlying liver disease and advanced stage liver cancer are associated with elevated neutrophil-lymphocyte ratio

• Wong L
• Bozhilov K
• Hernandez
• Kwee S
• Chan O
• Ellis L
• LeMarchand L

• KMID: 2459792
• DOI: http://doi.org/10.3350/cmh.2019.0004

Abstract

BACKGROUND/AIMS
Inflammation-based scores, such as the neutrophil-to-lymphocyte ratio (NLR), have been associated with prognosis in hepatocellular carcinoma (HCC); but variable cut-off values and potential lack of specificity have limited the utility of NLR. This study evaluates NLR in a large cohort of HCC patients.
METHODS
We retrospectively reviewed 789 HCC cases (1993-2017) for demographics, tumor characteristics, treatment, and survival. NLR was stratified into NLR ≥1.5 and NLR ≥3 and analyzed for correlation with American Joint Committee on Cancer (AJCC) and Barcelona Clinic Liver Cancer (BCLC) stages. In 235 patients who underwent liver resection, survival and recurrence were evaluated by NLR.
RESULTS
In 789 HCC cases, mean NLR was increased with advanced AJCC and BCLC stages. Hepatitis C patients were less likely to have NLR ≥1.5 and ≥3. Non-alcoholic steatohepatitis patients were more likely to have NLR ≥3. Patients with tumor size >5 cm, rupture, or macrovascular invasion were more likely to have NLR ≥3. In patients treated with resection, NLR ≥3 predicted early recurrence (odds ratio [OR] 4.14, P<0.01) and overall recurrence (OR 4.05, P<0.01). Mean NLR was 4.30 in those with recurrence and 2.75 in those without recurrence. Patients with NLR ≥3 showed significantly worse survival compared to those with NLR <3 (P<0.01 by log-rank test).
CONCLUSIONS
Elevated NLR is associated with advanced cancer stage and aggressive tumor characteristics, such as large size, rupture, and invasion. NLR ≥3 was associated with early and overall recurrence after resection but varied with etiology. NLR may be a useful biomarker in predicting recurrence for HCC patients undergoing curative resection, but further studies are required to elucidate the effect of disease etiology.

Keyword

Hepatocellular carcinoma; Liver cancer

MeSH Terms

Carcinoma, Hepatocellular
Cohort Studies
Demography
Fatty Liver
Hepatitis C
Humans
Joints
Liver Diseases*
Liver Neoplasms*
Liver*
Prognosis
Recurrence
Retrospective Studies
Rupture
Sensitivity and Specificity