Abstract
Purpose
Although alpha-fetoprotein (AFP) is a useful prognostic marker in patients with hepatocellular carcinoma (HCC), a recent study has shown that the preoperative neutrophil-to-lymphocyte ratio (NLR) is also associated with the postoperative survival in such patients.
Objective
To investigate the significance of the NLR in patients with primary HCC (p-HCC) showing a normal preoperative AFP.
Methods
Among 478 p-HCC patients undergoing curative surgery, 112 who had a normal AFP (< 8 ng/ml) were enrolled. The patients were divided into two groups: group A, who did not have an elevated NLR (≤ 3.2); and group B, who had an elevated NLR (> 3.2). Uni- and multivariate analyses were performed to compare clinical features with the overall survival (OS).
Results
A multivariate analysis of the clinical features showed that the NLR (> 3.2/≤ 3.2) (hazard ratio 2.366; 95% CI 1.069–5.235; P = 0.034) was closely associated with the OS, along with the age (> 65/≤ 65 years) (P = 0.033). Group B had a significantly lower survival ratio than group A in terms of not only the OS (P = 0.013), but also the cancer-specific survival (P = 0.002) and relapse-free survival (P = 0.039).
Conclusions
An elevated NLR (> 3.2) is predictive of a poor survival in patients with primary HCC (p-HCC) showing normal AFP levels.
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Abbreviations
- AFP:
-
Alpha-fetoprotein (α-fetoprotein)
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- CH:
-
Chronic hepatitis
- CRP:
-
C-reactive protein
- CSS:
-
Cancer-specific survival
- GPS:
-
Glasgow Prognostic Score
- HBV:
-
Hepatitis B virus
- HCC:
-
Hepatocellular carcinoma
- HCV:
-
Hepatitis C virus
- ICG R15:
-
Indocyanine green retention ratio at 15 min
- NL:
-
Normal liver
- NLR:
-
Neutrophil-to-lymphocyte ratio
- LC:
-
Liver cirrhosis
- OS:
-
Overall survival
- PIVKA II:
-
Protein induced by vitamin K absence or antagonists II
- RFS:
-
Relapse-free survival
- ROC curve:
-
Receiver operating characteristic curve
- SIR:
-
Systematic inflammatory response
- Va:
-
Hepatic arterial infiltration
- Vp:
-
Portal venous infiltration
- Vv:
-
Hepatic venous infiltration
- WBC:
-
White blood cell
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595_2019_1781_MOESM2_ESM.tif
Supplementary Fig. 1. The relationship between the NLR (NLR ≤3.2 and NLR >3.2 from top to bottom) and the overall survival in patients undergoing surgery for primary HCC with a preoperative serum level of alpha-fetoprotein >8 ng/ml (TIF 178 KB)
595_2019_1781_MOESM3_ESM.tif
Supplementary Fig. 2. The relationship between the NLR (NLR ≤3.2 and NLR >3.2 from top to bottom) and the cancer-specific survival in patients undergoing surgery for primary HCC with a preoperative serum level of alpha-fetoprotein >8 ng/ml (TIF 145 KB)
595_2019_1781_MOESM4_ESM.tif
Supplementary Fig. 3. The relationship between the NLR (NLR ≤3.2 and NLR >3.2 from top to bottom) and the relapse-free survival in patients undergoing surgery for primary HCC with a preoperative serum level of alpha-fetoprotein >8 ng/ml (TIF 131 KB)
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Shiraki, T., Ishizuka, M., Kubota, K. et al. An elevated neutrophil-to-lymphocyte ratio predicts a poor postoperative survival in primary hepatocellular carcinoma patients with a normal preoperative serum level of alpha-fetoprotein. Surg Today 49, 661–669 (2019). https://doi.org/10.1007/s00595-019-01781-1
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DOI: https://doi.org/10.1007/s00595-019-01781-1