Preoperative neutrophil-to-lymphocyte ratio as a prognostic predictor after curative-intent surgery for hepatocellular carcinoma: experience from a developing country

Abstract

Purpose: The aim of the study was to evaluate a prognostic value of preoperative neutrophil-to-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.

Keywords: cirrhosis; hepatocellular carcinoma; inflammation; liver resection; neutrophil-to-lymphocyte ratio.

Figure 1

Patient flow diagram. Abbreviations: HCC, hepatocellular carcinoma; HPB, hepato-pancreato-biliary; TACE, transarterial chemoembolization.

Figure 2

ROC curve analysis for neutrophil–lymphocyte ratio. (A) All patients group; (B) subgroup with cirrhosis; (C) subgroup without cirrhosis. Abbreviations: AUC, area under the curve; ROC, receiver operating characteristic.

Figure 3

Survival function curves for patients with and without cirrhosis.

Figure 4

Survival function curves for low and high NLR groups. (A) All patients group; (B) subgroup with cirrhosis; (C) subgroup without cirrhosis. Abbreviation: NLR, neutrophil-to-lymphocyte ratio.