Influence of preoperative neutrophil-to-lymphocyte ratio on early recurrence after curative resection in patients with hepatocellular carcinoma

doi:10.3969/j.issn.1673-8640.2016.010.006

Abstract

Abstract:

Objective To investigate the influence of preoperative neutrophil-to-lymphocyte ratio（NLR） on early recurrence after curative resection in patients with hepatocellular carcinoma（HCC）. Methods The clinical data of 195 HCC patients undergoing curative resection were analyzed retrospectively,and NLR was calculated according to preoperative neutrophil and lymphocyte counts. X-tile software was used to calculate the optimal cut-off value of NLR for tumor recurrence prediction,and the patients were classified into low NLR and high NLR groups. The recurrence prediction values of NLR in 195 patients and low-risk recurrence subgroups were evaluated by Kaplan-Meier curve and log-rank test. Univariate Cox regression model was used to determine the influence of preoperative clinical parameters on predicting recurrence,and multivariate Cox regression analysis was performed to investigate the preoperative clinical parameters with statistical significance.Results For 195 patients,the median follow-up time was 17.30 months,and 43.59% patients（85/195） suffered from tumor recurrence. The optimal cut-off value for NLR was 2.60,and HCC patients were classified into high NLR（≥2.60）group（40 cases）and low NLR（<2.60）group（155 cases）. Univariate analysis showed that preoperative alpha fetoprotein（AFP） >400 ng/mL（P<0.01）,tumor diameter >5 cm（P<0.01）,vascular invasion（P=0.03）,advanced Barcelona Clinic Liver Cancer（BCLC） stage（P=0.01） and high NLR（P<0.01）were influence factors for tumor recurrence free survival rate. Multivariate analysis showed that NLR was the strongest independent factor for tumor recurrence [OR（95%CI）=1.95（1.20-3.19）,P<0.01]. High NLR retained its prognostic value in AFP ≤400 ng/mL,single tumor,no vascular invasion and BCLC stage of 0+A（P<0.05）. High NLR was correlated with low differentiation,big tumor diameter and advanced BCLC stage（P<0.05）. Conclusions Preoperative NLR is a convenient,powerful,simple and low-cost parameter for HCC predicting early recurrence after curative resection. The cut-off value of 2.60 for NLR might be optimal for HCC patients undergoing curative resection in China. The determination of NLR can help with making effective and comprehensive treatment for HCC patients.

Key words: Neutrophil-to-lymphocyte ratio, Hepatocellular carcinoma, Curative resection, Early recurrence

CLC Number:

R446.1

MA Xiaolu, WU Jiong, ZHOU Yan, WANG Beili, ZHANG Chunyan, GUO Wei, PAN Baishen. Influence of preoperative neutrophil-to-lymphocyte ratio on early recurrence after curative resection in patients with hepatocellular carcinoma[J]. Laboratory Medicine, 2016, 31(10): 863-868.

Figures/Tables 5

References 20

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临床特征	NLR		P值
临床特征	<2.60	≥2.60	P值
年龄（岁）
≤50	48	12	0.91
>50	107	28	0.91
性别
男	136	36	0.69
女	19	4	0.69
肝硬化
无	31	7	0.72
有	124	33	0.72
HBsAg
阴性	19	13	0.69
阳性	136	27	0.69
ALT（U/L）
≤75	142	34	0.21
>75	13	6	0.21
AFP（ng/mL）
≤400	115	24	0.08
>400	40	16	0.08
Child-Pugh分级
A	152	37	0.07
B	3	3	0.07
肿瘤包膜
不完整	53	18	0.21
完整	102	22	0.21
病理分化
Ⅰ~Ⅱ	108	11	<0.01
Ⅲ~Ⅳ	47	29	<0.01
肿瘤直径（cm）
≤5	105	9	<0.01
>5	50	31	<0.01
肿瘤数量
单个	121	29	0.46
多个	34	11	0.46
血管侵犯
无	103	20	0.06
有	52	20	0.06
BCLC
0+A	117	23	0.02
B+C	38	17	0.02

临床特征	NLR		P值
临床特征	<2.60	≥2.60	P值
年龄（岁）
≤50	48	12	0.91
>50	107	28	0.91
性别
男	136	36	0.69
女	19	4	0.69
肝硬化
无	31	7	0.72
有	124	33	0.72
HBsAg
阴性	19	13	0.69
阳性	136	27	0.69
ALT（U/L）
≤75	142	34	0.21
>75	13	6	0.21
AFP（ng/mL）
≤400	115	24	0.08
>400	40	16	0.08
Child-Pugh分级
A	152	37	0.07
B	3	3	0.07
肿瘤包膜
不完整	53	18	0.21
完整	102	22	0.21
病理分化
Ⅰ~Ⅱ	108	11	<0.01
Ⅲ~Ⅳ	47	29	<0.01
肿瘤直径（cm）
≤5	105	9	<0.01
>5	50	31	<0.01
肿瘤数量
单个	121	29	0.46
多个	34	11	0.46
血管侵犯
无	103	20	0.06
有	52	20	0.06
BCLC
0+A	117	23	0.02
B+C	38	17	0.02

项目	变量	OR值	95%CI	P值
年龄	“>50岁”与“≤50岁”	0.67	0.43~1.03	0.07
性别	“男”与“女”	0.38	0.16~0.95	0.06
肝硬化	“有”与“无”	1.61	0.88~2.97	0.13
HBsAg	“阳性”与“阴性”	1.00	0.41~2.48	0.99
ALT	“>40 U/L”与 “≤40 U/L”	1.25	0.65~2.42	0.51
AFP	“>400 ng/mL”与 “≤400 ng/mL”	2.06	1.23~3.18	<0.01
Child- Pugh分级	“B”与“A”	1.99	0.73~5.43	0.18
肿瘤包膜	“完整”与“不整”	0.72	0.47~1.11	0.14
病理分化	“Ⅲ~Ⅳ”与“Ⅰ~Ⅱ”	1.19	0.78~1.83	0.42
肿瘤直径	“>5 cm”与“≤5 cm”	2.28	1.49~3.50	<0.01
肿瘤数量	“多个”与“单个”	1.39	0.85~2.18	0.20
血管侵犯	“有”与“无”	1.60	1.05~2.46	0.03
BCLC	“B+C”与“0+A”	1.76	1.14~2.73	0.01
NLR	“>2.60”与“≤2.60”	2.59	1.63~4.10	<0.01

项目	变量	OR值	95%CI	P值
年龄	“>50岁”与“≤50岁”	0.67	0.43~1.03	0.07
性别	“男”与“女”	0.38	0.16~0.95	0.06
肝硬化	“有”与“无”	1.61	0.88~2.97	0.13
HBsAg	“阳性”与“阴性”	1.00	0.41~2.48	0.99
ALT	“>40 U/L”与 “≤40 U/L”	1.25	0.65~2.42	0.51
AFP	“>400 ng/mL”与 “≤400 ng/mL”	2.06	1.23~3.18	<0.01
Child- Pugh分级	“B”与“A”	1.99	0.73~5.43	0.18
肿瘤包膜	“完整”与“不整”	0.72	0.47~1.11	0.14
病理分化	“Ⅲ~Ⅳ”与“Ⅰ~Ⅱ”	1.19	0.78~1.83	0.42
肿瘤直径	“>5 cm”与“≤5 cm”	2.28	1.49~3.50	<0.01
肿瘤数量	“多个”与“单个”	1.39	0.85~2.18	0.20
血管侵犯	“有”与“无”	1.60	1.05~2.46	0.03
BCLC	“B+C”与“0+A”	1.76	1.14~2.73	0.01
NLR	“>2.60”与“≤2.60”	2.59	1.63~4.10	<0.01

项目	变量	OR值	95%CI	P值
NLR	“>2.60”与“≤2.60”	1.95	1.20~3.19	<0.01
AFP	“>400 ng/mL”与 “≤400 ng/mL”	1.64	1.04~2.60	0.03
肿瘤直径	“>5 cm”与“≤5 cm”	1.57	0.97~2.52	0.07
血管侵犯	“有”与“无”	1.25	0.80~1.95	0.33
BCLC	“B+C”与“0+A”	1.31	0.83~2.06	0.25