Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb 22:16:137.
doi: 10.1186/s12885-016-2189-1.

A novel and accurate predictor of survival for patients with hepatocellular carcinoma after surgical resection: the neutrophil to lymphocyte ratio (NLR) combined with the aspartate aminotransferase/platelet count ratio index (APRI)

Fei Ji  1 , Yao Liang  2 , Shun-Jun Fu  3 , Zhi-Yong Guo  4 , Man Shu  5 , Shun-Li Shen  6 , Shao-Qiang Li  7 , Bao-Gang Peng  8 , Li-Jian Liang  9 , Yun-Peng Hua  10
Affiliations

A novel and accurate predictor of survival for patients with hepatocellular carcinoma after surgical resection: the neutrophil to lymphocyte ratio (NLR) combined with the aspartate aminotransferase/platelet count ratio index (APRI)

Fei Ji et al. BMC Cancer. .

Abstract

Background: The occurrence and development of hepatocellular carcinoma (HCC) depends largely on such non-tumor factors as inflammatory condition, immune state, viral infection and liver fibrosis. Various inflammation-based prognostic scores have been associated with survival in patients with HCC, such as the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and the prognostic nutritional index (PNI). The aspartate aminotransferase/platelet count ratio index (APRI) is thought to be a biomarker of liver fibrosis and cirrhosis. This study aims to evaluate the ability of these indices to predict survival in HCC patients after curative hepatectomy, and probe the increased prognostic accuracy of APRI combined with established inflammation-based prognostic scores.

Methods: Data were collected retrospectively from 321 patients who underwent curative resection for HCC. Preoperative NLR, PLR, PNI, APRI and clinico-pathological variables were analyzed. Univariate and multivariate analyses were performed to identify the predictive value of the above factors for disease-free survival (DFS) and overall survival (OS).

Results: Univariate analysis showed that NLR, PLR, PNI and APRI were significantly associated with DFS and OS in HCC patients with curative resection. Multivariate analysis showed that NLR and APRI were superior to PLR and PNI, and both were independently correlated with DFS and OS. Preoperative NLR >2 or APRI >1.68 predicted poor prognosis of patients with HCC after hepatectomy. Furthermore, the predictive range of NLR combined with APRI was more sensitive than that of either measure alone.

Conclusions: Preoperative NLR and APRI are independent predictors of DFS and OS in patients with HCC after surgical resection. Higher levels of NLR or APRI predict poorer outcomes in HCC patients. Intriguingly, combining NLR and APRI increases the prognostic accuracy of testing.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Determination of the cut-off value for NLR, PLR, PNI, APRI in HCC patients with hepatic resection
Fig. 2
Fig. 2
Relationship between NLR and DFS/OS of HCC patients after hepatectomy. a DFS of patients with NLR > 2 was significantly shorter than those with NLR ≤ 2 (P < 0.001, log-rank test). b OS of patients with NLR > 2 was also markedly shorter than those with NLR ≤ 2 (P < 0.001, log-rank test)
Fig. 3
Fig. 3
Relationship between APRI and DFS/OS of HCC patients after hepatectomy. a DFS of patients with APRI > 1.68 was significantly shorter than those with APRI ≤ 1.68 ( P < 0.001, log-rank test). b OS of patients with APRI > 1.68 was also markedly shorter than those with APRI ≤ 1.68 ( P < 0.001, log-rank test)
Fig. 4
Fig. 4
The combination of NLR and APRI was found to enhance prognostic accuracy for HCC. Disease-free survival curves (panel a) and overall survival curves (panel b). Group1, both NLR ≤ 2 and APRI ≤ 1.68; Group2, both NLR > 2 and APRI ≤ 1.68 or both NLR ≤ 2 and APRI > 1.68; Group3, both NLR > 2 and APRI > 1.68
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. El–Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132(7):2557–2576. doi: 10.1053/j.gastro.2007.04.061. - DOI - PubMed
    1. Ji F, Fu S-J, Shen S-L, Zhang L-J, Cao Q-H, Li S-Q, et al. The prognostic value of combined TGF-β1 and ELF in hepatocellular carcinoma. BMC Cancer. 2015;15(1):116. doi: 10.1186/s12885-015-1127-y. - DOI - PMC - PubMed
    1. Abdelgawad IA. Clinical utility of simple non-invasive liver fibrosis indices for predicting hepatocellular carcinoma (HCC) among Egyptian patients. J Clin Pathol. 2015;68(2):154–160. doi: 10.1136/jclinpath-2014-202462. - DOI - PubMed
    1. Mano Y, Shirabe K, Yamashita Y-i, Harimoto N, Tsujita E, Takeishi K, et al. Preoperative neutrophil-to-lymphocyte ratio is a predictor of survival after hepatectomy for hepatocellular carcinoma: a retrospective analysis. Ann Surg. 2013;258(2):301–305. doi: 10.1097/SLA.0b013e318297ad6b. - DOI - PubMed
    1. Pinato D, North B, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI) Br J Cancer. 2012;106(8):1439–1445. doi: 10.1038/bjc.2012.92. - DOI - PMC - PubMed

Publication types

MeSH terms

Substances