Lu Shi-Dong, Wang Yan-Yan, Peng Ning-Fu, Peng Yu-Chong, Zhong Jian-Hong, Qin Hong-Gui, Xiang Bang-De, You Xue-Mei, Ma Liang, Li Le-Qun
From the Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China (S-DL, Y-YW, N-Fp, Y-CP, J-HZ, H-GQ, B-DX, X-MY, LM, L-QL); and Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning, PR China (N-FP, J-HZ, B-DX, X-MY, LM, L-QL).
Medicine (Baltimore). 2016 Feb;95(5):e2722. doi: 10.1097/MD.0000000000002722.
This study aims to clarify the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) for patients with hepatocellular carcinoma (HCC) after potentially curative hepatic resection (HR). The prognostic value of the NLR for HCC patients has not been definitely reviewed by large studies, especially for those with different Barcelona Clinic Liver Cancer (BCLC) stages.A consecutive sample of 963 HCC patients who underwent potentially curative HR was classified as having low or high NLR using a cut-off value of 2.81. Overall survival (OS) and tumor recurrence were compared for patients with low or high NLR across the total population, as well as in subgroups of patients in BCLC stages 0/A, B, or C. Clinicopathological parameters, including NLR, were evaluated to identify risk factors of OS and tumor recurrence after potentially curative hepatic resection. Multivariate analyses were performed using the Cox proportional hazards model or subdistribution hazard regression model.Multivariate analyses showed that NLR (>2.81), tumor number (>3), incomplete capsule, serum albumin (≤35 g/L), alanine transaminase activity (>40 U/L), and macrovascular invasion were risk factors for low OS, whereas NLR (>2.81), tumor size (>5 cm), alpha fetal protein concentration (>400 ng/L), and macrovascular invasion were risk factors for low tumor recurrence. NLR > 2.81 was significantly associated with poor OS and tumor recurrence in the total patient population (both P < 0.001), as well as in the subgroups of patients in BCLC stages 0/A or B (all P < 0.05). Moreover, those with high NLR were associated with low OS (P = 0.027), and also with slightly higher tumor recurrence than those with low NLR for the subgroups in BCLC stage B (P = 0.058). Neither association, however, was observed among patients with BCLC stage C disease.NLR may be an independent predictor of low OS and tumor recurrence after potentially curative HR in HCC patients in BCLC stages 0/A or B.
本研究旨在阐明术前中性粒细胞与淋巴细胞比值（NLR）对肝细胞癌（HCC）患者在接受潜在根治性肝切除（HR）后的预后价值。NLR对HCC患者的预后价值尚未得到大型研究的确切评估，尤其是对于那些处于不同巴塞罗那临床肝癌（BCLC）分期的患者。对963例行潜在根治性HR的HCC患者连续样本，使用临界值2.81将其分为NLR低或高两组。比较了总体人群以及BCLC 0/A期、B期或C期患者亚组中NLR低或高的患者的总生存期（OS）和肿瘤复发情况。评估包括NLR在内的临床病理参数，以确定潜在根治性肝切除术后OS和肿瘤复发的危险因素。使用Cox比例风险模型或亚分布风险回归模型进行多因素分析。多因素分析显示，NLR（>2.81）、肿瘤数量（>3）、包膜不完整、血清白蛋白（≤35 g/L）、丙氨酸转氨酶活性（>40 U/L）和大血管侵犯是OS低的危险因素，而NLR（>2.81）、肿瘤大小（>5 cm）、甲胎蛋白浓度（>400 ng/L）和大血管侵犯是肿瘤复发低的危险因素。NLR>2.81与总体患者人群的OS差和肿瘤复发显著相关（均P<0.001），以及BCLC 0/A期或B期患者亚组（均P<0.05）。此外，NLR高的患者与OS低相关（P = 0.027），并且对于BCLC B期亚组，其肿瘤复发也略高于NLR低的患者（P = 0.058）。然而，在BCLC C期疾病患者中未观察到这种相关性。NLR可能是BCLC 0/A期或B期HCC患者在接受潜在根治性HR后OS低和肿瘤复发的独立预测因子。
