Synchronous splenectomy and hepatectomy for patients with small hepatocellular carcinoma and pathological spleen: neutrophil to lymphocyte ratio changes can predict the prognosis
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Xiaoyun Zhang1, Chuan Li1,*, Tianfu Wen1, Wei Peng1, Lunan Yan1, Bo Li1, Jiayin Yang1, Wentao Wang1, Mingqing Xu1 and Yong Zeng1
1Department of Liver Surgery and Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
*These authors have contributed equally to this work
Tianfu Wen, email: [email protected]
Keywords: hepatocellular carcinoma, splenomegaly, hypersplenism, hepatectomy, neutrophil to lymphocyte ratio
Received: January 09, 2017 Accepted: March 17, 2017 Published: May 10, 2017
Background: Treatments about small hepatocellular carcinoma (HCC) and hypersplenism associated with good hepatic reserve are not well established. The aim of this study was to investigate the outcome of synchronous hepatectomy and splenectomy for those patients.
Study Design: Splenomegaly and hypersplenism were defined as a pathological spleen. Seven hundred fifty-six patients with small HCC (381 with a pathological spleen, 375 without a pathological spleen) were divided into three groups. One hundred ten of 381 patients underwent synchronous hepatectomy and splenectomy (group A), 271 of 381 patients underwent hepatectomy alone (Group B) and 375 patients without pathological spleen underwent hepatectomy alone (Group C).
The influence of pathological spleen, outcome of different treatments and systemic inflammatory response indexes were analyzed.
Results: Both overall survival (OS, P=0.023) and disease-free survival (DFS, P=0.020) were significantly increased in group C compared to group B. A pathological spleen was a significant independent prognostic factor for OS and DFS among those two groups. In addition, OS (P=0.025) and DFS (P=0.004) were increased in the group A compared to group B. Splenectomy and neutrophil to lymphocyte ratio changes (ΔNLR) were significant independent prognostic factors of the prognosis for patients in groups A and B.
Conclusions: A Pathological spleen influences the outcome of HCC patients. Synchronous hepatectomy and splenectomy should be performed among patients with small HCC and a pathological spleen. ΔNLR can predict the prognosis of these patients.
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