中性粒细胞与淋巴细胞比值对肝细胞癌肝移植术后结局的负面影响。

Negative impact of neutrophil-lymphocyte ratio on outcome after liver transplantation for hepatocellular carcinoma.

作者信息

Halazun Karim J, Hardy Mark A, Rana Abbas A, Woodland David C, Luyten Elijah J, Mahadev Suhari, Witkowski Piotr, Siegel Abbey B, Brown Robert S, Emond Jean C

机构信息

Department of Organ Transplantation, New York Presbyterian Hospital, Columbia University, MHB-7GS-313, 177 Ft Washington Avenue, New York, NY 10032, USA.

出版信息

Ann Surg. 2009 Jul;250(1):141-51. doi: 10.1097/SLA.0b013e3181a77e59.

DOI:10.1097/SLA.0b013e3181a77e59

PMID:19561458

Abstract

BACKGROUND

The Milan criteria have been adopted by United Network for Organ Sharing (UNOS) to preoperatively assess outcome in patients with hepatocellular carcinoma (HCC) who receive orthotopic liver transplantation (OLT). These criteria rely solely on radiographic appearances of the tumor, providing no measure of tumor biology. Recurrence rates, therefore, remain around 20% for patients within the criteria. The neutrophil-lymphocyte ratio (NLR) is an indicator of inflammatory status previously established as a prognostic indicator in colorectal liver metastases. We aimed to determine whether NLR predicts outcome in patients undergoing OLT for HCC.

DESIGN

Analysis of patients undergoing OLT for HCC between 2001 and 2007 at our institution. A NLR > or =5 was considered to be elevated.

RESULTS

: A total of 150 patients were identified, with 13 patients having an elevated NLR. Of these, 62% developed recurrence compared with 14% with normal NLR (P < 0.0001). The disease-free survival for patients with high NLR was significantly worse than that for patients with normal NLR (1-, 3-, and 5-year survivals of 38%, 25%, and 25% vs. 92%, 85%, and 75%, P < 0.0001). Patients with high NLR also had poorer overall survival (5-year survival, 28% vs. 64%, P = 0.001). Patients within Milan with an elevated NLR had significantly poorer disease-free survival than those with normal NLR within Milan (5-year survival, 30% vs. 81%, P < 0.0001). On univariate analysis, 9 factors including an NLR > or =5 were significant predictors of poor disease-free survival. However, only a raised NLR remained significant on multivariate analysis (P = 0.005, HR: 19.98).

CONCLUSION

Elevated NLR significantly increases the risk for tumor recurrence and recipient death. Preoperative NLR measurement may provide a simple method of identifying patients with poorer prognosis and act as an adjunct to Milan in determining, which patients benefit most from OLT.

摘要

背景

器官共享联合网络（UNOS）采用米兰标准对接受原位肝移植（OLT）的肝细胞癌（HCC）患者进行术前预后评估。这些标准完全依赖于肿瘤的影像学表现，未对肿瘤生物学特性进行评估。因此，符合该标准的患者复发率仍在20%左右。中性粒细胞与淋巴细胞比值（NLR）是一种炎症状态指标，此前已被确立为结直肠癌肝转移的预后指标。我们旨在确定NLR是否能预测接受OLT治疗的HCC患者的预后。

设计

对2001年至2007年在我院接受OLT治疗的HCC患者进行分析。NLR≥5被认为升高。

结果

共确定150例患者，其中13例NLR升高。其中，62%发生复发，而NLR正常者为14%（P<0.0001）。NLR高的患者无病生存期明显低于NLR正常的患者（1年、3年和5年生存率分别为38%、25%和25%，而正常者为92%、85%和75%，P<0.0001）。NLR高的患者总体生存期也较差（5年生存率，28%对vs.64%，P=0.001）。米兰标准内NLR升高的患者无病生存期明显低于米兰标准内NLR正常的患者（5年生存率，30%对vs.81%，P<0.0001）。单因素分析显示，包括NLR≥5在内的9个因素是无病生存期差的显著预测因素。然而，多因素分析中只有升高的NLR仍然显著（P=0.005，HR：19.98）。