Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8398
Revised: October 8, 2013
Accepted: November 3, 2013
Published online: December 7, 2013
Processing time: 213 Days and 10 Hours
AIM: To determine whether an elevated neutrophil-lymphocyte ratio (NLR) is negatively associated with tumor recurrence in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after liver transplantation (LT), and to determine the optimal predictive NLR cut-off value.
METHODS: The data of HCC patients who had undergone LT came from the China Liver Transplant Registry database. We collected data from 326 liver cancer patients who had undergone LT at our medical center. We divided the patients into groups based on their NLRs (3, 4 or 5). We then compared the clinicopathological data and long-time survival between these groups. Meanwhile, we used receiver operating characteristic analysis to determine the optimal NLR cut-off.
RESULTS: Of 280 HCC patients included in this study, 263 were HBV positive. Patients with an NLR < 3 and patients with an NLR ≥ 3 but < 4 showed no significant differences in overall survival (OS) (P = 0.212) or disease-free survival (DFS) (P = 0.601). Patients with an NLR ≥ 4 but < 5 and patients with an NLR ≥ 5 also showed no significant differences in OS (P = 0.208) or DFS (P = 0.618). The 1-, 3- and 5-year OS rates of patients with an NLR < 4 vs an NLR ≥ 4 were 87.8%, 63.8% and 61.5% vs 73.9%, 36.7% and 30.3%, respectively (P < 0.001). The 1-, 3- and 5-year DFS rates of patients with an NLR < 4 vs NLR ≥ 4 were 83.9%, 62.9% and 60.7% vs 64.9%, 30.1% and 30.1%, respectively (P < 0.001). Univariate and multivariate analyses demonstrated that three factors, including NLR ≥ 4 (P = 0.002), were significant predictors of tumor recurrence in HCC patients after LT.
CONCLUSION: A preoperative elevated NLR significantly increased the risk for tumor recurrence in HCC patients after LT.
Core tip: Inflammation has been linked to the biological characteristics of tumors. The neutrophil-lymphocyte ratio (NLR) is a simple biomarker of inflammation. Several studies have reported that a preoperative elevated NLR (in peripheral blood) is negatively associated with the prognosis of patients with hepatocellular carcinoma (HCC) after liver transplantation (LT). However, the ideal cut-off value is controversial, with studies citing both 3 and 5 as the appropriate cut-off NLR. In this study, we report 326 HCC patients who had undergone LT at our center. We identify NLR = 4 as the cut-off point for predicting the prognosis of HCC patients after LT.