Stratified neutrophil-to-lymphocyte ratio accurately predict mortality risk in hepatocellular carcinoma patients following curative liver resection
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Gui-Qian Huang1,2,*, Gui-Qi Zhu1,3,*, Yan-Long Liu4,*, Li-Ren Wang1,3, Martin Braddock5, Ming-Hua Zheng1,6, Meng-Tao Zhou7
1Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
2Renji School of Wenzhou Medical University, Wenzhou 325000, China
3School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China
4College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, 325035, China
5Global Medicines Development, AstraZeneca R&D, Alderley Park, United Kingdom
6Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China
7Department of Hepatobiliary Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
Ming-Hua Zheng, e-mail: firstname.lastname@example.org
Meng-Tao Zhou, e-mail: email@example.com
Keywords: neutrophil-to-lymphocyte ratio, hepatocellular carcinoma, curative liver resection, overall survival
Received: November 23, 2015 Accepted: December 14, 2015 Published: December 21, 2015
Objectives: Neutrophil lymphocyte ratio (NLR) has been shown to predict prognosis of cancers in several studies. This study was designed to evaluate the impact of stratified NLR in patients who have received curative liver resection (CLR) for hepatocellular carcinoma (HCC).
Methods: A total of 1659 patients who underwent CLR for suspected HCC between 2007 and 2014 were reviewed. The preoperative NLR was categorized into quartiles based on the quantity of the study population and the distribution of NLR. Hazard ratios (HRs) and 95% confidence intervals (CIs) were significantly associated with overall survival (OS) and derived by Cox proportional hazard regression analyses. Univariate and multivariate Cox proportional hazard regression analyses were evaluated for association of all independent parameters with disease prognosis.
Results: Multivariable Cox proportional hazards models showed that the level of NLR (HR = 1.031, 95%CI: 1.002-1.060, P = 0.033), number of nodules (HR = 1.679, 95%CI: 1.285-2.194, P<0.001), portal vein thrombosis (HR = 4.329, 95%CI: 1.968-9.521, P<0.001), microvascular invasion (HR = 2.527, 95%CI: 1.726-3.700, P<0.001) and CTP score (HR = 1.675, 95%CI: 1.153-2.433, P = 0.007) were significant predictors of mortality. From the Kaplan-Meier analysis of overall survival (OS), each NLR quartile showed a progressively worse OS and apparent separation (log-rank P=0.008). The highest 5-year OS rate following CLR (60%) in HCC patients was observed in quartile 1. In contrast, the lowest 5-year OS rate (27%) was obtained in quartile 4.
Conclusions: Stratified NLR may predict significantly improved outcomes and strengthen the predictive power for patient responses to therapeutic intervention.
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