Department of MedicineUniversity of California, San FranciscoSan FranciscoCA.
Division of GastroenterologyDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCA.
Liver Transpl. 2021 Jun;27(6):818-829. doi: 10.1002/lt.26010.
We assessed the prognostic significance and the clinical stability of the neutrophil-to-lymphocyte ratio (NLR) before liver transplantation (LT) in a large cohort of patients with hepatocellular carcinoma (HCC) from a region with a long waitlist time. A high preoperative NLR ≥5 has been reported to predict poor outcomes following LT for HCC, and the NLR has been incorporated into several prognostic models. We evaluated 758 patients with HCC with Model for End-Stage Liver Disease exceptions and listed for LT from 2002 to 2015 at a single LT center, of which 505 underwent LT and 253 dropped out before LT. The NLR was collected in all patients at LT and, if available, between 15 and 90 days before LT (NLR2) or at dropout. An NLR ≥5 was associated with microvascular invasion (MVI), poorer tumor differentiation, and more advanced pathology on explant. Patients with an NLR ≥5 exhibited no differences in alpha-fetoprotein, tumor burden at listing, or number of locoregional therapies compared with patients with an NLR <5. After a median post-LT follow-up of 4.7 years, overall survival and recurrence rates were similar for patients with an NLR ≥5 versus patients with an NLR <5. The NLR changed frequently, and 47% of patients whose NLR2 was ≥5 had an NLR <5 by LT. The NLR was ≥5 in 47.6% of patients at dropout compared with 14.9% of patients undergoing LT. Although the NLR at LT correlated with MVI and tumor stage at explant, the NLR did not predict post-LT survival or HCC recurrence. The NLR appeared to be a relatively unstable inflammatory marker during the immediate 3 months before LT for HCC.
我们评估了在一个等待时间较长的地区，来自大肝癌（HCC）患者队列的中性粒细胞与淋巴细胞比值（NLR）在肝移植（LT）前的预后意义和临床稳定性。术前 NLR≥5 已被报道可预测 HCC 患者 LT 后的不良结局，并且 NLR 已被纳入几种预后模型中。我们评估了 2002 年至 2015 年在一个 LT 中心接受 LT 并有终末期肝病模型（MELD）例外且被列入名单的 758 例 HCC 患者，其中 505 例进行了 LT，253 例在 LT 前退出。在所有患者 LT 时以及在 LT 前 15 至 90 天（NLR2）或在退出时，如果有可用的话，收集 NLR。NLR≥5 与微血管侵犯（MVI）、肿瘤分化较差和肝移植标本中更晚期的病理学相关。与 NLR<5 的患者相比，NLR≥5 的患者在 AFP、列入名单时的肿瘤负担或局部区域治疗次数方面无差异。在 LT 后中位随访 4.7 年后，NLR≥5 的患者与 NLR<5 的患者的总体生存率和复发率相似。NLR 变化频繁，NLR2≥5 的患者中有 47%的患者在 LT 时 NLR<5。与进行 LT 的患者相比，退出时 NLR≥5 的患者占 47.6%，而进行 LT 的患者占 14.9%。尽管 LT 时的 NLR 与肝移植标本中的 MVI 和肿瘤分期相关，但 NLR 不能预测 LT 后的生存或 HCC 复发。在 HCC 进行 LT 前的 3 个月内，NLR 似乎是一种相对不稳定的炎症标志物。
