Li SH, Wang QX, Yang ZY, Jiang W, Li C, Sun P, Wei W, Shi M, Guo RP. Prognostic value of the neutrophil-to-lymphocyte ratio for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis. World J Gastroenterol 2017; 23(17): 3122-3132 [PMID: 28533669 DOI: 10.3748/wjg.v23.i17.3122]
Corresponding Author of This Article
Rong-Ping Guo, MD, Department of Hepatobiliary Surgery, Cancer Center of Sun Yat-Sen University, 651 Dongfeng East Road, Guangzhou 510275, Guangdong Province, China. guorp@sysucc.org.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastroenterol. May 7, 2017; 23(17): 3122-3132 Published online May 7, 2017. doi: 10.3748/wjg.v23.i17.3122
Table 1 Correlation between each neutrophil-to-lymphocyte ratio cut-off and overall survival of hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis using the Kaplan-Meier method
Cut-off value
Group
Cases
1-yr OS
2-yr OS
3-yr OS
5-yr OS
χ2
P value
1.0
NLR ≤ 1 vs > 1
5 vs 76
80.0% vs 46.9%
40.0% vs 27.7%
40.0% vs 19.0%
0.0% vs 17.3%
0.272
0.602
1.5
NLR ≤ 1.5 vs > 1.5
16 vs 65
80.0% vs 41.5%
46.7% vs 24.2%
26.7% vs 19.8%
6.7% vs 19.8%
1.575
0.210
2.0
NLR ≤ 2 vs > 2
28 vs 53
72.3% vs 37.3%
44.2% vs 20.7%
28.1% vs 17.8%
16.1% vs 17.8%
3.657
0.056
2.5
NLR ≤ 2.5 vs > 2.5
39 vs 42
64.5% vs 35.1%
39.2% vs 18.9%
25.2% vs 18.9%
16.8% vs 18.9%
3.935
0.047
2.6
NLR ≤ 2.6 vs > 2.6
42 vs 39
62.1% vs 35.4%
38.5% vs 17.7%
24.7% vs 17.7%
16.5% vs 17.7%
3.987
0.046
2.7
NLR ≤ 2.7 vs > 2.7
44 vs 37
59.1% vs 37.3%
36.6% vs 18.7%
23.6% vs 18.7%
15.7% vs 18.7%
2.254
0.133
2.8
NLR ≤ 2.8 vs > 2.8
49 vs 32
60.2% vs 32.7%
39.1% vs 13.1%
26.1% vs 13.1%
18.3% vs 13.1%
6.007
0.014
2.9
NLR ≤ 2.9 vs > 2.9
51 vs 30
59.8% vs 31.5%
39.5% vs 10.5%
26.3% vs 10.5%
18.4% vs 10.5%
7.227
0.007
3.0
NLR ≤ 3 vs > 3
53 vs 28
59.8% vs 32.1%
38.8% vs 10.7%
25.9% vs 10.7%
18.1% vs 10.7%
6.158
0.013
3.5
NLR ≤ 3.5 vs > 3.5
62 vs 19
56.7% vs 26.3%
34.4% vs 10.5%
23.7% vs 10.5%
17.2% vs 10.5%
2.843
0.092
4.0
NLR ≤ 4 vs > 4
66 vs 15
56.2% vs 20.0%
33.8% vs 6.7%
23.9% vs 6.7%
17.9% vs 6.7%
5.284
0.022
4.5
NLR ≤ 4.5 vs > 4.5
72 vs 9
51.1% vs 33.3%
30.7% vs 11.1%
21.7% vs 11.1%
16.3% vs 11.1%
1.724
0.189
5.0
NLR ≤ 5 vs > 5
75 vs 6
50.3% vs 33.3%
29.4% vs 16.7%
20.7% vs 16.7%
15.6% vs 16.7%
0.527
0.468
Table 2 Clinicopathological characteristics of the 81 hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis, n (%)
NLR ≤ 2.9 (n = 51)
NLR > 2.9 (n = 30)
P value
Age in years
48.49 ± 1.52
48.47 ± 2.28
0.993
Gender
0.292
Male
48 (94.1)
30 (100.0)
Female
3 (5.9)
0 (0.0)
HBsAg status
0.281
Negative
3 (5.9)
0 (0.0)
Positive
45 (88.2)
30 (100.0)
Unknown
3 (5.9)
0 (0.0)
Preoperative HBV DNA
0.025
< 1 × 103
19 (37.3)
4 (13.3)
≥ 1 × 103
23 (45.1)
19 (63.3)
Unknown
9 (17.6)
7 (23.3)
Preoperative AFP level
0.038
< 400 ng/mL
19 (37.3)
5 (16.7)
≥ 400 ng/mL
30 (58.8)
25 (83.3)
Unknown
2 (3.9)
0 (0.0)
Preoperative ALT level (U/L)
41 (10-713)
42.5 (21-146.5)
0.697
Preoperative Hgb level (g/L)
147.79 ± 2.43
148.52 ± 4.37
0.884
Preoperative PLT level (109/L)
185.84 ± 12.73
201.97 ± 13.97
0.417
Preoperative Child-Pugh score
0.017
Child A (5)
21 (41.2)
7 (23.3)
Child A (6)
22 (43.1)
14 (46.7)
Child B (7)
4 (7.8)
5 (16.7)
Child B (8)
1 (2.0)
2 (6.7)
Child B (9)
0 (0.0)
1 (3.3)
Unknown
3 (5.9)
1 (3.3)
Preoperative ICGR15 (%)
6.42 ± 0.79
5.37 ± 0.94
0.404
Number of tumors
0.474
Solitary
28 (54.9)
14 (46.7)
Multiple
23 (45.1)
16 (53.3)
Maximum diameter of tumor (cm)
8.93 ± 0.58
11.88 ± 0.80
0.003
Uni/bilobular disease
0.414
Unilobular disease
48 (94.1)
26 (86.7)
Bilobular disease
3 (5.9)
4 (13.3)
Adjacent organ invasion
0.722
Negative
32 (62.7)
20 (66.7)
Positive
19 (37.3)
10 (33.3)
Operative procedure
0.215
Minor
45 (88.2)
23 (76.7)
Major
6 (11.8)
7 (23.3)
Total occlusion time of the hepatic inflow (min)
17.89 ± 1.58
18.18 ± 2.53
0.918
Total operative time (min)
168.43 ± 7.19
205.00 ± 13.77
0.011
Blood loss (mL)
579.41 ± 61.82
891.67 ± 171.61
0.095
Blood transfusion (mL)
0.061
No
33 (64.7)
13 (43.3)
Yes
18 (35.3)
17 (56.7)
Surgical margin
0.002
≤ 1 cm
33 (64.7)
25 (83.3)
> 1 cm
18 (35.3)
1 (3.3)
Unknown
0 (0.0)
4 (13.3)
Histological grade of tumor cells
0.958
I-II
19 (37.3)
11 (36.7)
III-IV
32 (62.7)
19 (63.3)
Postoperative complication
0.792
Negative
42 (82.4)
24 (80.0)
Positive
9 (17.6)
6 (20.0)
Postoperative hospital stay (d)
11 (8-28)
11.5 (8-83)
0.468
Table 3 Patterns of recurrence and postoperative treatments in the patients of the two groups, n (%)
NLR ≤ 2.9
NLR > 2.9
P value
Recurrence
n = 51
n = 30
1.000
Negative
3 (5.9)
1 (3.3)
Positive
39 (76.5)
23 (76.7)
Unknown
9 (17.6)
6 (20)
Recurrence pattern
n = 39
n = 23
0.832
Intrahepatic only
26 (66.7)
15 (65.2)
Extrahepatic only
2 (5.1)
2 (8.7)
Both
11 (28.2)
6 (26.1)
Treatments
n = 51
n = 30
TACE
23
15
Hepatectomy
2
0
PMCT
4
0
Systemic chemotherapy
3
2
RFA
5
0
PEI
2
0
CIK
0
2
TAI
1
1
Sorafenib
0
1
Radiotherapy
1
0
Sealed source radiotherapy
1
2
Traditional Chinese medicine
4
0
Supportive care only
21
12
Table 4 Univariate and multivariate analyses of factors affecting overall survival
Variables
Univariate analysis for OS
Multivariate analysis for OS
HR
95%CI
P value
HR
95%CI
P value
NLR > 2.9
1.969
1.190-3.259
0.008
1.866
1.048-3.322
0.034
Age ≤ 50 yr
1.532
0.913-2.569
0.106
Female
2.035
0.625-6.623
0.238
HBsAg (+)
1.055
0.327-3.402
0.929
HBV-DNA > 1 × 103
1.258
0.709-2.234
0.432
AFP ≥ 400 ng/mL
2.026
1.163-3.527
0.013
1.863
1.024-3.392
0.042
ALT ≤ 40 U/L
1.122
0.684-1.839
0.649
Hgb > 130 g/L
1.964
0.987-3.909
0.054
PLT > 100 × 109/L
1.168
0.467-2.916
0.740
Child A
1.090
0.564-2.106
0.798
ICGR15 ≤ 10%
1.642
0.746-3.610
0.218
Multiple tumors
1.676
1.022-2.748
0.041
1.084
0.627-1.876
0.772
Maximum diameter of tumor > 5 cm
1.869
0.973-3.593
0.061
Bilobular disease
2.764
1.153-6.628
0.023
3.292
1.215-8.918
0.019
Adjacent organ invaded
1.268
0.756-2.127
0.369
Major hepatectomy
1.145
0.597-2.195
0.683
Pringle maneuver
1.937
0.950-3.952
0.069
Operation time > 180 min
1.352
0.819-2.233
0.238
Intraoperative blood loss > 1000 mL
1.721
0.957-3.096
0.070
Intraoperative blood transfusion
1.485
0.901-2.448
0.121
Surgical margin ≤ 1 cm
1.868
1.024-3.408
0.042
1.195
0.596-2.394
0.616
Histologic grade III-IV
1.220
0.736-2.020
0.440
Postoperative complication
1.467
0.807-2.667
0.209
Postoperative hospital stay ≤ 10 d
1.078
0.646-1.798
0.774
Table 5 Univariate and multivariate analyses of factors affecting disease-free survival
Variables
Univariate analysis for DFS
Multivariate analysis for DFS
HR
95%CI
P value
HR
95%CI
P value
NLR > 2.9
1.720
1.017-2.907
0.043
1.553
0.850-2.837
0.153
Age ≤ 50 yr
1.424
0.842-2.409
0.188
Female
1.593
0.384-6.610
0.522
HBsAg (+)
1.314
0.407-4.249
0.648
HBV-DNA > 1 × 103
1.426
0.772-2.634
0.257
AFP ≥ 400 ng/mL
2.099
1.196-3.684
0.010
1.732
0.954-3.146
0.071
ALT ≤ 40 U/L
1.272
0.771-2.098
0.346
Hgb > 130 g/L
2.629
1.266-5.460
0.010
2.051
0.940-4.476
0.071
PLT ≤ 100 × 109/L
1.147
0.413-3.186
0.793
Child B
1.254
0.631-2.492
0.518
ICGR15 ≤ 10%
2.470
1.052-5.796
0.038
2.134
0.870-5.236
0.098
Multiple tumors
1.189
0.709-1.992
0.512
Maximum diameter of tumor > 5 cm
1.865
0.944-3.686
0.073
Bilobular disease
1.778
0.753-4.199
0.189
Adjacent organ not invaded
1.119
0.659-1.899
0.677
Major hepatectomy
1.253
0.635-2.474
0.516
Pringle maneuver
1.922
0.933-3.960
0.076
Operation time ≤ 180 min
1.067
0.638-1.785
0.805
Intraoperative blood loss > 1000 mL
1.854
1.012-3.396
0.046
1.258
0.649-2.437
0.497
Intraoperative blood transfusion
1.655
0.972-2.817
0.064
Surgical margin ≤ 1 cm
1.492
0.827-2.690
0.183
Histologic grade I-II
1.083
0.648-1.808
0.761
Postoperative complication
1.173
0.608-2.264
0.634
Postoperative hospital stay > 10 d
1.041
0.616-1.759
0.882
Citation: Li SH, Wang QX, Yang ZY, Jiang W, Li C, Sun P, Wei W, Shi M, Guo RP. Prognostic value of the neutrophil-to-lymphocyte ratio for hepatocellular carcinoma patients with portal/hepatic vein tumor thrombosis. World J Gastroenterol 2017; 23(17): 3122-3132