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. 2020 Feb;9(2):441-457.
doi: 10.21037/tcr.2019.11.29.

The prognostic significance of neutrophil-to-lymphocyte ratio at different time points in patients with hepatocellular carcinoma receiving liver resection

Tianxing Dai  1 , Guozhen Lin  1 , Mingbin Deng  1 , Shuguang Zhu  1   2 , Haibo Li  1   2 , Jia Yao  1   2 , Hua Li  1   2 , Wei Liu  3 , Yang Yang  1   2 , Guihua Chen  2   3 , Guoying Wang  1   2
Affiliations

The prognostic significance of neutrophil-to-lymphocyte ratio at different time points in patients with hepatocellular carcinoma receiving liver resection

Tianxing Dai et al. Transl Cancer Res. 2020 Feb.

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) has been demonstrated a significant association with the prognosis of hepatocellular carcinoma (HCC). The current study aimed to evaluate the prognostic value of NLR at different time points in HCC patients receiving liver resection.

Methods: Data were retrospectively collected from 195 HCC patients receiving liver resection. The preoperative NLR (pre-NLR), postoperative NLR (post-NLR) and corresponding changes of NLR (NLRc) at different time points were calculated. The disease-free survival (DFS) and overall survival (OS) was calculated by the Kaplan-Meier method and compared by the log-rank test. Both univariate and multivariate analyses were performed to evaluate their prognostic values for DFS and OS. And the prognostic significance of pre-NLR, post-NLRs, and NLRcs were further evaluated with subgroup analysis and with early and late recurrence of HCC.

Results: Pre-NLR was not significantly correlated with DFS or OS (both P>0.05), whereas higher post-NLR at 4-8 weeks [NLR (4-8 w)] and 3-6 months [(NLR (3-6 m)] predicted worse DFS (P=0.023 and P<0.001, respectively) and OS (P=0.012 and P=0.001, respectively). The value of area under the curve (AUC) of NLR (3-6 m) were higher than NLR (4-8 w) for DFS (0.656 vs. 0.572) and OS (0.650 vs. 0.621). Multivariate analyses showed that NLRc (4-8 w) was not a significant predictor of DFS (P=0.369) or OS (P=0.173), while the NLRc (3-6 m) with 25% increase was found to be an independent factor for adverse DFS in patients with HCC (P=0.041). The AUC of NLRc (3-6 m) for DFS was 0.600. Subgroup analysis showed NLR (3-6 m) was significantly corrected to DFS (P<0.001) and OS (P=0.001) in patients with cirrhosis. And NLR (3-6 m) also showed with significant correlation with early recurrence (P<0.001), while NLR (4-8 w) was found with significant association both with early and late recurrence (P=0.037 and P=0.027, respectively).

Conclusions: The post-NLRs are significant predictors of clinical outcome in HCC patients receiving liver resection, and post-NLR and NLRc with a relatively long-term interval after operation have better prognostic values.

Keywords: Disease-free survival (DFS); hepatocellular carcinoma (HCC); neutrophil-to-lymphocyte ratio (NLR); overall survival (OS); prognosis.

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Conflict of interest statement

Conflicts of Interest: The authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2019.11.29). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for disease-free survival and overall survival of 195 patients with HCC receiving liver resection. Diseases-free survival (A), and overall survival (B).
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves for disease-free survival and overall survival of NLRs and NLRcs in HCC patients. Diseases-free survival (A), and overall survival (B).
Figure 3
Figure 3
Kaplan-Meier curves for disease-free survival of NLRs and NLRcs in HCC patients. Pre-NLR (A), NLR (4–8 w) (B), NLR (3–6 m) (C), NLRc (4–8 w) (D) and NLRc (3–6 m) (E).
Figure 4
Figure 4
Kaplan-Meier curves for overall survival of NLRs and NLRcs in HCC patients. Pre-NLR (A), NLR (4–8 w) (B), NLR (3–6 m) (C), NLRc (4–8 w) (D) and NLRc (3–6 m) (E).
Figure 5
Figure 5
Kaplan-Meier curves for diseases-free survival of NLRs and NLRcs in HCC patients with and without cirrhosis. Without cirrhosis: pre-NLR (A), NLR (4–8 w) (C), NLR (3–6 m) (E), NLRc (4–8 w) (G) and NLRc (3–6 m) (I); With cirrhosis: pre-NLR (B), NLR (4–8 w) (D), NLR (3–6 m) (F), NLRc (4–8 w) (H) and NLRc (3–6 m) (J).
Figure 6
Figure 6
Kaplan-Meier curves for overall survival of NLRs and NLRcs in HCC patients with and without cirrhosis. Without cirrhosis: pre-NLR (A), NLR (4–8 w) (C), NLR (3–6 m) (E), NLRc (4–8 w) (G) and NLRc (3–6 m) (I); with cirrhosis: pre-NLR (B), NLR (4–8 w) (D), NLR (3–6 m) (F), NLRc (4–8 w) (H) and NLRc (3–6 m) (J).
Figure 7
Figure 7
Kaplan-Meier curves for early diseases-free survival of NLRs and NLRcs in HCC patients. Pre-NLR (A), NLR (4–8 w) (B), NLR (3–6 m) (C), NLRc (4–8 w) (D) and NLRc (3–6 m) (E).
Figure 8
Figure 8
Kaplan-Meier curves for late diseases-free survival of NLRs and NLRcs in HCC patients. Pre-NLR (A), NLR (4–8 w) (B), NLR (3–6 m) (C), NLRc (4–8 w) (D) and NLRc (3–6 m) (E).
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