Neutrophil and platelet-to-lymphocyte ratio as new predictors of dropout and recurrence after liver transplantation for hepatocellular cancer

Abstract

Summary There is increasing evidence that systemic inflammation markers like neutrophil (NLR) and platelet‐to‐lymphocyte ratios (PLR) may play a role in the outcome of hepatocellular cancer (HCC). Between January 1994 and March 2012, 181 patients with HCC were registered on the transplant waiting list: 35 (19.3%) patients dropped out during the waiting period and 146 (80.7%) patients underwent liver transplantation (LT). The median follow‐up of this patient cohort was 4.2 years (IQR: 1.8–8.3). On c‐statistics, the last NLR (AUROC = 67.4; P = 0.05) was the best predictor of dropout. The last PLR had an intermediate statistical ability (AUROC = 66.1; P = 0.07) to predict post‐LT tumor recurrence. Patients with a NLR value >5.4 had poor 5‐year intention‐to‐treat (ITT) survival rates (48.2 vs. 64.5%; P = 0.02). Conversely, PLR better stratified patients in relation to tumor‐free survival (TFS) (80.7 vs. 91.6%; P = 0.02). NLR is a good predictor for the risk of dropout, while PLR is a good predictor for the risk of post‐LT recurrence. Use of these markers, which are all available before LT, may represent an additional tool to refine the selection criteria of HCC liver recipients.

Clinical significance of pre-operative neutrophil lymphocyte ratio and platelet lymphocyte ratio as prognostic factors for patients with colorectal cancer

“…Instead, NLR and PLR, calculated from leukocyte differential counts and platelet counts, respectively, are more readily available and inexpensive compared to CRP (7). Notably, numerous previous studies have already indicated that an elevated NLR and PLR is associated with a poorer survival in patients with ovarian (8), breast (9,10), non-small cell lung (11), esophageal (12,13), gastric (7,14) and hepatocellular cancers (15) and CRC (2,(16)(17)(18). NLR is the ratio of the absolute neutrophil count to the absolute lymphocyte count, and therefore the association between a high NLR and a poor prognosis, as revealed in the present study, is possibly indicative of the tumor-promoting activity associated with neutrophilia in the tumor environment.…”

“…Notably, the scope and effects of an inflammatory reaction have always been assessed according to a number of biochemical markers, including the neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR), which are inexpensive markers of systemic inflammation (7). Previous studies have indicated that elevated NLR or PLR suggested a poor prognosis for various types of cancer, including ovarian (8), breast (9,10), non-small cell lung (11), esophageal (12,13), gastric (7,14), hepatocellular (15) and CRC (2,(16)(17)(18). However, the current literature leaves certain questions unanswered.…”

Inflammation-based scores and hepatocellular carcinoma - authors' reply

“…4,5 In all studies, 2-5 approximately 30% of the patients were outside the Milan criteria; however, there was no analysis of inflammatory markers in association with these criteria apart from 1 study. 2 In that study, patients outside the Milan criteria with high NLRs had significantly worse tumor-free survival than those with low NLRs.…”

How to Increase the Efficiency in Research on Non-Surgical Interventions during Cancer Surgery?

“…Hepatocellular cancer is the fifth tumor-related cause of death, and associated with a significant rate of postoperative relapse even with complete excision, such as during liver transplantation [1]. Increased aggressiveness of minimal residual disease and immune cells activity modulation may play a role in the perioperative period.…”

“…Increased aggressiveness of minimal residual disease and immune cells activity modulation may play a role in the perioperative period. In particular neutrophils are associated with the activation of protumoral processes, whereas some T lymphocytes can exert an antitumoral role [1][2][3]. These observations have triggered considerations for specific interventions during surgery, to limit the proliferative activity of cancer cells, such as to improve anticancer immune activity [4].…”