Prognostic value of combined preoperative fibrinogen and neutrophil-lymphocyte ratio in patients with hepatocellular carcinoma after liver transplantation
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Shun-Jun Fu1,2,3,4,*, Fei Ji1,2,3,*, Ming Han1,2,3,*, Mao-Gen Chen1,2,3, Xiao-Ping Wang1,2,3, Wei-Qiang Ju1,2,3, Qiang Zhao1,2,3, Lin-Wei Wu1,2,3, Qing-Qi Ren1,2,3, Zhi-Yong Guo1,2,3, Dong-Ping Wang1,2,3, Xiao-Feng Zhu1,2,3, Yi Ma1,2,3, Xiao-Shun He1,2,3
1Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China
2Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China
3Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, P. R. China
4Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, China
*These authors contributed equally to this work
Xiao-Shun He, email: email@example.com
Yi Ma, email: firstname.lastname@example.org
Keywords: fibrinogen, neutrophil–lymphocyte ration, hepatocellular carcinoma, prognosis, liver transplantation
Received: July 27, 2016 Accepted: November 02, 2016 Published: December 07, 2016
Objectives: Elevated plasma fibrinogen (Fib) correlated with patient’s prognosis in several solid tumors. However, few studies have illuminated the relationship between preoperative Fib and prognosis of HCC after liver transplantation. We aimed to clarify the prognostic value of Fib and whether the prognostic accuracy can be enhanced by the combination of Fib and neutrophil–lymphocyte ratio (NLR).
Results: Fib was correlated with Child-pugh stage, alpha-fetoprotein (AFP), size of largest tumor, macro- and micro-vascular invasion. Univariate analysis showed preoperative Fib, AFP, NLR, size of largest tumor, tumor number, macro- and micro- vascular invasion were significantly associated with disease-free survival (DFS) and overall survival (OS) in HCC patients with liver transplantation. After multivariate analysis, only Fib and macro-vascular invasion were independently correlated with DFS and OS. Survival analysis showed that preoperative Fib > 2.345 g/L predicted poor prognosis of patients HCC after liver transplantation. Preoperative Fib showed prognostic value in various subgroups of HCC. Furthermore, the predictive range was expanded by the combination of Fib and NLR.
Materials and Methods: Data were collected retrospectively from 130 HCC patients who underwent liver transplantation. Preoperative Fib, NLR and clinicopathologic variables were analyzed. The survival analysis was performed by the Kaplan-Meier method, and compared by the log-rank test. Univariate and multivariate analyses were performed to identify the prognostic factors for DFS and OS.
Conclusions: Preoperative Fib is an independent effective predictor of prognosis for HCC patients, higher levels of Fib predict poorer outcomes and the combination of Fib and NLR enlarges the prognostic accuracy of testing.
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