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

Authors Galun D, Bogdanovic A, Kovac Djokic J, Bulajic P, Loncar Z, Zuvela M

Received 3 January 2018

Accepted for publication 8 March 2018

Published 4 May 2018 Volume 2018:10 Pages 977—988

DOI https://doi.org/10.2147/CMAR.S161398

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Leylah Drusbosky


Danijel Galun,1,2 Aleksandar Bogdanovic,1 Jelena Djokic Kovac,2,3 Predrag Bulajic,1 Zlatibor Loncar,2,4 Marinko Zuvela1,2

1HPB Unit, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia; 2Medical School, University of Belgrade, Belgrade, Serbia; 3Center for Radiology and Magnetic Resonance Imaging, Clinical Center of Serbia, Belgrade, Serbia; 4Emergency Center, Clinical Center of Serbia, Belgrade, Serbia


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: neutrophil-to-lymphocyte ratio, hepatocellular carcinoma, cirrhosis, inflammation, liver resection

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