Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Surg. 2013 Aug;258(2):301-5. doi: 10.1097/SLA.0b013e318297ad6b.
To clarify the prognostic value of the preoperative blood neutrophil-to-lymphocyte ratio (NLR) in patients undergoing hepatectomy for hepatocellular carcinoma (HCC).
Although a high NLR has been reported to be a predictor of poor survival in patients with various cancers, it has not been extensively examined in patients with HCC.
This retrospective study enrolled 958 patients who underwent hepatectomy without preoperative therapy for HCC from 1996 to 2009. Clinicopathological parameters, including NLR, were evaluated to identify predictors of overall and recurrence-free survival after hepatectomy. Univariate and multivariate analyses were performed, using the Cox proportional hazards model. The best cutoff was determined with time-dependent receiver operating characteristic curve. To determine the mechanism of NLR elevation, immunohistological examination using CD163 staining was performed in 150 patients.
Univariate and multivariate analyses showed that NLR was an independent prognostic factor in overall and recurrence-free survival. The best cutoff of NLR was 2.81, and 238 of 958 patients (24.8%) had NLR of more than 2.81. The 5-year survival rate after hepatectomy was 72.9% in patients with NLR less than 2.81 and 51.5% in those with NLR 2.81 or more (P < 0.0001). CD163-positive cell counts were significantly higher in tumors in the group with NLR 2.81 or more than in the group with NLR less than 2.81 (P = 0.0004).
Our results show that NLR is an independent predictor of survival after hepatectomy in patients with HCC. Accumulation of tumor-associated macrophages in the tumor is associated with a high NLR.
阐明术前中性粒细胞与淋巴细胞比值（NLR）对肝细胞癌（HCC）患者肝切除术预后的预测价值。
虽然高 NLR 已被报道为多种癌症患者生存不良的预测因素，但在 HCC 患者中尚未广泛研究。
本回顾性研究纳入了 1996 年至 2009 年期间未经术前治疗接受肝切除术治疗 HCC 的 958 例患者。评估包括 NLR 在内的临床病理参数，以确定肝切除术后总生存和无复发生存的预测因素。使用 Cox 比例风险模型进行单因素和多因素分析。使用时间依赖性接受者操作特征曲线确定最佳截止值。为了确定 NLR 升高的机制，对 150 例患者进行了使用 CD163 染色的免疫组织化学检查。
单因素和多因素分析显示，NLR 是总生存和无复发生存的独立预后因素。NLR 的最佳截止值为 2.81，958 例患者中有 238 例（24.8%）的 NLR 大于 2.81。NLR 小于 2.81 的患者肝切除术后 5 年生存率为 72.9%，NLR 为 2.81 或更高的患者为 51.5%（P < 0.0001）。NLR 为 2.81 或更高的组中肿瘤内 CD163 阳性细胞计数明显高于 NLR 小于 2.81 的组（P = 0.0004）。
我们的研究结果表明，NLR 是 HCC 患者肝切除术后生存的独立预测因子。肿瘤中肿瘤相关巨噬细胞的积累与高 NLR 相关。
