Neutrophil-lymphocyte ratio predicts overall and recurrence-free survival after liver transplantation for hepatocellular carcinoma (original) (raw)
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Prognostic significance of the neutrophil-lymphocyte ratio (NLR) in phase 1 clinical trial patients
Journal of Clinical Oncology, 2014
Backgrounds: Neutrophil-lymphocyte ratio (NLR) has recently been reported as a predictor of Hepatocellular carcinoma (HCC). However, its prognostic value in HCC still remains controversial. In this study, we aimed to evaluate the association between NLR and clinical outcome of HCC patients by performing meta-analysis. Methods: A comprehensive literature search for relevant studies published up to August 2013 was performed by using PubMed, Ovid, the Cochrane Library and Web of Science databases. Meta-analysis was performed using hazard ratio (HR) or odds ratio (OR) and 95% confidence intervals (95% CIs) as effect measures. Results: A total of 15 studies encompassing 3094 patients were included in this meta-analysis. Our pooled results showed that high NLR was associated with poor overall survival (OS) and disease free survival (DFS) in HCC initially treated by liver transplantation (
Transplantation, 2011
Background. Systemic inflammation markers, such as neutrophil-to-lymphocyte ratio (NLR), have recently emerged as the prognostic factors for recurrence of liver tumors. Methods. We assessed the ability of NLR and of other variables to predict the outcomes of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). A retrospective analysis was performed in 219 patients with HCC who underwent OLT between 1997 and 2009, with a median follow-up of 40 months. Results. Overall 3-and 5-year patient survival rates were 76.6% and 70.7%, respectively. Overall 3-and 5-year recurrence-free survival (RFS) rates were 83.8% and 82.1%, respectively. On univariate analysis, the factors affecting overall survival were ␣-fetoprotein more than 30 ng/mL (Pϭ0.006), NLR more than or equal to 5 (PϽ0.0001), hepatitis C infection (Pϭ0.043), and presence of microvascular invasion (MVI; Pϭ0.006). Preoperative treatments (Pϭ0.006), ␣-fetoprotein more than 30 ng/mL (Pϭ0.003), NLR more than or equal to 5 (PϽ0.0001), exceeding Milan criteria at final histology (Pϭ0.001), poor tumor differentiation (Pϭ0.02), and presence of MVI (PϽ0.0001) predicted a lower RFS. Cox's proportional hazard model showed that only increased NLR and presence of MVI independently predicted overall survival and RFS. Conclusions. NLR is an important predictor of outcome after OLT for HCC and should be used to identify OLT candidates at high risk of recurrence.
A new score to predict outcome after liver transplantation
Journal of Translational Medicine and Research, 2015
Background: An ideal liver allocation system should reduce waitlist mortality and also improve post-transplant survival. Aim: To identify a new scoring system that predicts recipient survival at 3 months following liver transplantation (LT) in the Romanian program. Methods: We included into analysis 242 adult patients (183 patients within the training set and 59 in the validation cohort) with liver cirrhosis consecutively transplanted between January 2012 and June 2014. Results: Post-transplant overall survival was 84.2% at 3 months. Independent risk factors for survival following LT were: recipient age >53 years (p=0.01), serum albumin <2.7g/dl (p=0.02), diabetes mellitus (p=0.14), hyponatremia <130mmol/L, presence of non-malignant portal vein thrombosis (p=0.01), retransplantation (p=0.0005) and donor resuscitation following cardiac arrest (p=0.03). AUROC of RoSOFT score is 0.86 in both training and validation set. Diagnostic accuracy of RoSOFT for predicting 3 months mortality is 89.6%. Recipients with HCC outside Milan criteria had a significantly lower MELD score at LT compared to patients inside Milan (p=0.008) and received a higher proportion of marginal organs (p=0.005), but survival did not differ (p=0.47). Conclusions: Combined recipient and donor risk factors can accurately predict 3-months survival following LT in our National LT Program and can be used to improve donorrecipient matching.
Cancer Management and Research
The aim of the study was to evaluate a prognostic value of preoperative neutrophilto-lymphocyte ratio (NLR) on long-term survival of cirrhotic and noncirrhotic hepatocellular cancer (HCC) patients managed by a curative-intent liver surgery in a developing country. Patients and methods: During the study period between November 1, 2001, and December 31, 2012, 109 patients underwent potentially curative hepatectomy for HCC. Data were retrospectively reviewed from the prospectively collected database. The median follow-up was 25 months. NLR was estimated by dividing an absolute neutrophil count by an absolute lymphocyte count from the differential blood count. Receiver operating characteristic curve was constructed to assess the ability of NLR to predict long-term outcomes and to determine an optimal cutoff value for all patients group, the subgroup with cirrhosis, and the subgroup without cirrhosis. The optimal cutoff values were 1.28, 1.28, and 2.09, respectively. Results: The overall 3-and 5-year survival rates were 49% and 45%, respectively, for low NLR group and 38% and 26% , respectively, for high NLR group. The difference was statistically significant (p=0.015). Overall survival was similar between low and high NLR groups in patients with cirrhosis; no difference was found between the groups (p=0.124). In patients without cirrhosis, low NLR group had longer overall survival compared with high NLR group (p=0.015). Univariate analysis identified four factors as significant predictors of long-term survival: cirrhosis, Child-Pugh score, platelet count, and NLR. On multivariate analysis, only platelet count and NLR were independent prognostic factors of long-term survival. Conclusion: Prognostic value of NLR was confirmed in noncirrhotic HCC patients who underwent curative-intent liver surgery. In HCC patients with cirrhosis, the prognostic role of NLR was not confirmed.
Oncotarget
The ARQ 197-215 study randomized patients to tivantinib or placebo and pre-specified efficacy analyses indicated the predictive value of MET expression as a marker of benefit from tivantinib in hepatocellular carcinoma (HCC). We aimed to explore the neutrophil-to-lymphocyte ratio (NLR) in 98 ARQ 197-215 patients with available absolute neutrophil count and absolute lymphocyte count at baseline. The cutoff value used to define high versus low NLR was 3.0. In univariate analysis, high NLR was associated with hazard ratio (HR) for overall survival (OS) of 1.58 [95% confidence interval (CI) 1.01; 2.47; P <0.046], corresponding to median OS of 5.1 months versus 7.8 months in patients with low NLR (P = 0.044). In contrast, time to progression was not significantly affected by NLR (P = 0.20). Multivariable model confirmed that both NLR >3 (P = 0.03) and presence of vascular invasion (P = 0.017) were negatively associated with OS. After adjustment for vascular invasion, NLR independently predicted survival in both the placebo and the tivantinib cohort. For OS, no interaction was detected between NLR status and treatment (P interaction = 0.40). Baseline NLR is an independent prognostic biomarker in patients with HCC and compensated liver function who are candidate for second-line treatments.
American Journal of Transplantation, 2004
We examined whether consideration of repeated model for end-stage liver disease (MELD) measurements for patients listed for liver transplantation improves predictive value beyond current MELD alone. Clinical data were extracted for all adult primary liver transplantation candidates from our institution who were listed with the United Network for Organ Sharing (UNOS) between 1990 and 1999. Serum creatinine, bilirubin, and international normalized ratio (INR) were obtained from an institutional laboratory database. Cox models were constructed using current MELD, change in MELD (Delta), and number of MELD scores to predict survival on the waiting list. Eight hundred and sixty-one patients met inclusion criteria, 639 underwent transplantation, and 80 died while waiting. A one-unit increment in current MELD imparted significant hazard ratios ranging from 1.12 to 1.19 in all models. Delta MELD was predictive of mortality univariately, but less predictive when current MELD was included, and not predictive when considered with both current and number of MELD scores. Overall, current MELD is the single most important determinant of mortality risk on the waiting list. Delta MELD is predictive of death only within 4 d of the event; however, part of this correlates with the dying process itself, thus limiting Delta MELD's utility in survival prediction models.
World Journal of Surgery, 2008
Background This study was designed to evaluate the impact of an elevated preoperative neutrophil-to-lymphocyte ratio (NLR) on outcome after curative resection for hepatocellular carcinoma (HCC). Methods Patients undergoing resection for HCC from January 1994 to May 2007 were identified from the hepatobiliary database. Demographics, laboratory analyses, and histopathology data were analyzed. Results A total of 96 patients were identified with a median age at diagnosis of 65 (range, 15-85) years. The 1-, 3-, and 5-year overall survival rates were 80%, 58%, and 52%, respectively. Although the presence of microvascular invasion, NLR C5, and R1 resection margin were adverse predictors of overall survival, there were no independent predictors identified on multivariate analysis. The 1-, 3-, and 5-year disease-free survival rates were 74%, 63%, and 57%, respectively. Preoperative tumor biopsy, NLR C 5, multiple liver tumors, microvascular invasion, and R1 resection margin were all predictors of poorer disease-free survival. Multivariate analysis showed that a NLR C 5 and R1 resection margin were independent predictors of poorer disease-free survival. The median disease-free survival of those with a NLR C 5 was 8 months compared with 18 months for those with a NLR \ 5. Conclusion Preoperative NLR C 5 was an adverse predictor of disease-free and overall survival.