Tajiri Kazuto, Baba Hayato, Kawai Kengo, Minemura Masami, Yasumura Satoshi, Takahara Terumi, Sugiyama Toshiro
The Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
Diagnostic Pathology, Faculty of Medicine, University of Toyama, Toyama, Japan.
J Gastroenterol Hepatol. 2016 Jul;31(7):1291-9. doi: 10.1111/jgh.13287.
Radiofrequency ablation (RFA) is an established treatment for small hepatocellular carcinoma (HCC) wherein non-recurrence is essential for long-term survival. Recently, neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation that is associated with tumor-associated macrophages (TAMs), was suggested to be a prognostic marker of HCC treated with RFA. Therefore, we evaluated predictive factors, including NLR, associated with recurrence after curative RFA.
A total of 163 patients initially diagnosed with HCC and treated with RFA were enrolled. We retrospectively analyzed factors associated with recurrence and survival after RFA. Furthermore, TAMs were evaluated using surgically resected specimens.
Hepatitis C virus (HCV) infection was the most frequent cause of HCC in this population (111 cases, 68.1%), whereas hepatitis B virus (HBV) infection accounted for 26 cases (16.0%). Recurrence, mostly intrahepatic distant recurrence, was found in 101 cases (61.9%). Recurrence and posttreatment NLR were independent prognostic factors related to survival, and male sex, HCV infection, serum des-γ-carboxy prothrombin > 40 AU/L, and posttreatment NLR were associated with recurrence. Pretreatment NLR showed no association with recurrence, whereas posttreatment NLR showed prognostic value. Interestingly, pretreatment NLR > 2.5 was significantly associated with recurrence in HBV-HCC patients (odds ratio 3.439, P = 0.037) not but HCV-HCC (odds ratio 1.430, P = 0.17). Furthermore, TAMs were increased in the peripheral area of HCCs with HBV infection compared with those with HCV.
Recurrence of HCC after RFA was strongly associated with survival. NLR is useful as a predictive marker of recurrence, especially in HBV-HCC patients.
射频消融（RFA）是治疗小肝细胞癌（HCC）的一种既定疗法，其中无复发对于长期生存至关重要。最近，中性粒细胞与淋巴细胞比值（NLR），一种与肿瘤相关巨噬细胞（TAM）相关的全身炎症标志物，被认为是接受RFA治疗的HCC的预后标志物。因此，我们评估了包括NLR在内的与根治性RFA后复发相关的预测因素。
共纳入163例最初诊断为HCC并接受RFA治疗的患者。我们回顾性分析了与RFA后复发和生存相关的因素。此外，使用手术切除标本评估TAM。
丙型肝炎病毒（HCV）感染是该人群中HCC最常见的病因（111例，68.1%），而乙型肝炎病毒（HBV）感染占26例（16.0%）。101例（61.9%）出现复发，主要为肝内远处复发。复发和治疗后NLR是与生存相关的独立预后因素，男性、HCV感染、血清去γ-羧基凝血酶原>40 AU/L和治疗后NLR与复发相关。治疗前NLR与复发无关，而治疗后NLR具有预后价值。有趣的是，治疗前NLR>2.5与HBV-HCC患者的复发显著相关（比值比3.439；P=0.037），而与HCV-HCC患者无关（比值比1.430；P=0.17）。此外，与HCV感染的HCC相比，HBV感染的HCC外周区域的TAM增加。
RFA后HCC的复发与生存密切相关。NLR可作为复发的预测标志物，尤其是在HBV-HCC患者中。
