Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2018; 24(15): 1658-1665
Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1658
Platelet-to-lymphocyte ratio in the setting of liver transplantation for hepatocellular cancer: A systematic review and meta-analysis
Quirino Lai, Fabio Melandro, Zoe Larghi Laureiro, Francesco Giovanardi, Stefano Ginanni Corradini, Flaminia Ferri, Redan Hassan, Massimo Rossi, Gianluca Mennini
Quirino Lai, Fabio Melandro, Zoe Larghi Laureiro, Francesco Giovanardi, Redan Hassan, Massimo Rossi, Gianluca Mennini, Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Rome 00161, Italy
Stefano Ginanni Corradini, Flaminia Ferri, Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome 00161, Italy
Author contributions: Lai Q contributed to conception and design of the study; Lai Q, Melandro F, Giovanardi F, Ferri F and Hassan R contributed to acquisition of data; Lai Q and Melandro F analysed and interpreted the data; Lai Q drafted the article; Ginanni Corradini S, Rossi M and Mennini G critically revised the manuscript; and all authors approved the final version.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Quirino Lai, MD, PhD, Senior Lecturer, Hepato-bilio-pancreatic and Liver Transplant Unit, Department of Surgery, Sapienza University of Rome, Umberto I Policlinic of Rome, Viale del Policlinico 155, Rome 00161, Italy.
Telephone: +39-3493020126 Fax: +39-06499701
Received: March 9, 2018
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

More studies aimed at better understanding biological and clinical mechanisms of the link between PLR and HCC are necessary.