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Title: [Correlation between postoperative neutrophil to lymphocyte ratio and recurrence and prognosis of hepatocellular carcinoma after radical liver resection].
Author: Wu XL, Bi XY, Li ZY, Zhao H, Zhao JJ, Zhou JG, Huang Z, Zhang YF, Cai JQ.
Journal: Zhonghua Zhong Liu Za Zhi; 2018 May 23; 40(5):365-371. PubMed ID: 29860764.
Abstract:
Objective: To investigate the correlation between postoperative peripheral blood neutrophil to lymphocyte ratio (NLR) and recurrence and prognosis of patients with hepatocellular carcinoma (HCC). Methods: The clinicopathological and follow-up data of 344 patients with HCC who underwent radical liver resection from May 2010 to April 2014 were analyzed retrospectively. Results: Of the 344 patients, 104 had early recurrence and 84 had late recurrence. Receiver operating characteristic (ROC) curve analysis showed that the NLR predicted area under the curve (AUC) of early recurrence was 0.622 (P<0.001), the optimal cut-off value was 2.41. The AUC of late recurrence was 0.634 (P=0.001), the optimal cut-off value was 2.15. Cox multivariate analysis showed the serum concentration of hepatitis B surface antigen (HR=2.508, 95% CI: 1.311-4.798), microvascular invasion (HR=2.422, 95% CI: 1.239-4.734), Milan criteria (HR=2.373, 95% CI: 1.427-3.948) and postoperative NLR (HR=2.285, 95% CI: 1.379-3.788) were independent risk factors of early recurrence after HCC resection. Postoperative NLR (HR=2.927, 95% CI: 1.630-5.255), liver cirrhosis (HR=2.531, 95% CI: 1.291-4.962) and serum concentration of albumin (HR=2.257, 95% CI: 1.251-4.073) were independent risk factors of late recurrence after HCC resection. The median recurrence-free survival (RFS) of the 344 patients was 45.0 months, and the median overall survival (OS) was 63.2 months. ROC curve analysis showed that the postoperative NLR predicted 5-year survival AUC was 0.689 (P<0.05), with an optimal cutoff of 2.29. Cox multivariate analysis showed microvascular invasion (HR=2.247, 95% CI: 1.534-3.291), postoperative NLR (HR=2.217, 95% CI: 1.653-2.974), and liver cirrhosis (HR=1.685, 95% CI: 1.168-2.431), Milan criteria (HR=1.679, 95% CI: 1.238-2.277), serum concentration of hepatitis B surface antigen (HR=1.623, 95% CI: 1.102-2.392), serum concentration of albumin (HR=1.43, 95% CI: 1.066-1.918) were independent factors of RFS after HCC resection, while microvascular invasion (HR=3.862, 95% CI: 2.407-6.197), Barcelona staging (HR=2.864, 95% CI: 1.600-5.125), postoperative NLR (HR=2.688, 95% CI: 1.782-4.055), liver cirrhosis (HR=2.039, 95% CI: 1.184-3.514), serum concentration of albumin (HR=1.81, 95% CI: 1.204-2.720) were independent factors of OS. Conclusions: For HCC patients who receive radical liver resection, postoperative NLR ≥2.29 implicates poor prognosis. Moreover, postoperative NLR ≥2.41 suggests early recurrence, while NLR ≥2.15 suggests late recurrence. 目的：探讨肝癌手术后中性粒细胞和淋巴细胞比值(NLR)与肝癌患者复发、生存的关系。 方法：收集2010年5月至2014年4月间行根治性切除的344例原发性肝细胞癌(HCC)患者的临床病理资料和随访资料。绘制术后NLR预测复发和生存的受试者工作特征(ROC)曲线并确定最佳界值，采用单因素和多因素分析评价复发和生存的影响因素。 结果： 344例患者中，早期复发104例，晚期复发84例。ROC曲线分析显示，术后NLR预测早期复发的曲线下面积(AUC)为0.622(P<0.001)，最佳界值为2.41；预测晚期复发的AUC为0.634(P＝0.001)；最佳界值为2.15。Cox多因素分析显示，乙肝表面抗原(HR＝2.508，95%CI：1.311～4.798)、微血管侵犯(HR＝2.422，95%CI：1.239～4.734)、米兰标准(HR＝2.373，95%CI：1.427～3.948)、术后NLR(HR＝2.285，95%CI：1.379～3.788)是HCC切除术后早期复发的独立影响因素，术后NLR(HR＝2.927，95%CI：1.630～5.255)、肝硬化(HR＝2.531，95%CI：1.291～4.962)、白蛋白(HR＝2.257，95%CI：1.251～4.073)是HCC切除术后晚期复发的独立影响因素。344例患者的中位无复发生存时间(RFS)为45.0个月，中位总生存时间(OS)为63.2个月。ROC曲线分析显示，术后NLR预测患者5年生存的AUC为0.689(P<0.05)，最佳界值为2.29。Cox多因素分析显示，微血管侵犯(HR＝2.247，95%CI：1.534～3.291)、术后NLR(HR＝2.217, 95% CI：1.653～2.974)、肝硬化(HR＝1.685，95%CI：1.168～2.431)、米兰标准(HR＝1.679，95%CI：1.238～2.277)、乙肝表面抗原(HR＝1.623，95%CI：1.102～2.392)、白蛋白(HR＝1.43，95%CI：1.066～1.918)为HCC切除术后RFS的独立影响因素，微血管侵犯(HR＝3.862，95%CI：2.407～6.197)、巴塞罗那分期(HR＝2.864，95%CI：1.600～5.125)、术后NLR(HR＝2.688，95%CI：1.782～4.055)、肝硬化(HR＝2.039，95%CI：1.184～3.514)、白蛋白(HR＝1.81，95%CI：1.204～2.720)为OS的独立影响因素。 结论：对于根治性手术切除的HCC患者，术后NLR≥2.29提示预后不良，≥2.41提示具有早期复发风险，≥2.15提示具有晚期复发风险。.

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