Peritransplant Lymphopenia Is a Novel Prognostic Factor in Recurrence of Hepatocellular Carcinoma After Liver Transplantation

Nagai, Shunji; Abouljoud, Marwan; Kazimi, Marwan; Brown, Kimberly; Moonka, Dilip; Yoshida, Atsushi

doi:10.1097/01.tp.0000437426.15890.1d

Cited by 50 publications

(62 citation statements)

References 29 publications

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“…On the other hand, lymphocytes are major compartments of the immune system, which play a vital role in defending against tumors [31]. A high NLR indicated an imbalance in the immune response, which impaired the normal anti-tumor functions; thus, tumor recurrence and invasion may occur [26,32]. In the present study, as limitations inherent to its retrospective design, we could not collect the serum VEGF data.…”

Section: Discussionmentioning

confidence: 69%

High pretreatment neutrophil–lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer

Shao

Cai

2015

Clin Transl Oncol

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Section: Discussionmentioning

confidence: 69%

High pretreatment neutrophil–lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer

Shao

Cai

2015

Clin Transl Oncol

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“…Therefore, it should be noted that after transplant, surgical stress, perioperative immunosuppression, and malnourishment influence patients' immune status including a perioperative leukopenia. 15 Other laboratory parameters were not affected. In this context, it must be noted that we did not use creatinine clearance and neutropenia as possible laboratory parameters, but instead creatinine in serum and leukopenia.…”

Section: Discussionmentioning

confidence: 86%

Untitled

2016

Exp Clin Transplant

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“…IL-17 itself has been associated with worse OS and increased risk of recurrence as it has been shown to upregulate tumor angiogenesis (70)(71)(72). On the other hand, overall lymphopenia has been associated with poor outcomes after LT as well (73). Additionally, elevated AFP, microvascular invasion, and presence of multifocal tumors and extrahepatic metastasis, all factors associated with poor outcomes in HCC patients, are significantly associated with NLR (49,72,74).…”

Section: Neutrophil Lymphocyte Ratio (Nlr)mentioning

confidence: 97%

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Rosenblatt

Tafesh

Halazun

2017

Transl. Gastroenterol. Hepatol.

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Since the advent of the Milan criteria in 1996 and its widespread adoption for selection of patients with hepatocellular carcinoma (HCC) who would benefit from transplant, there has been an extensive hunt for the ideal clinical biomarker to predict HCC recurrence. This is because Milan lack does not include tumor biology indices and recurrence rates remain in the 15-20% range worldwide. While a 'silver-bullet' biomarker has not been found, several useful inflammatory markers have been identified and used in scoring systems that supersede Milan in their ability to predict HCC recurrence post liver transplantation (LT). In this review, we aim to summarize the role of inflammatory markers paly in the selection of HCC patients awaiting LT. measured characteristic to indicate a biological process or response (19). They have the potential to assess the risk of recurrence in HCC without invasive testing, offering yet another tool in a physician's armamentarium to identify the patients who would benefit from LT and those who would not. Currently, several biomarkers are utilized in clinical practice, but both the AASLD and an international consensus (15,20) describe biomarkers as an area of future study. Alpha fetoprotein (AFP) (21)(22)(23)(24) and proteins induced by vitamin K absence II (PIVKA-II) (25-28) have been extensively studied and validated as predictors of HCC outcomes. However, there are patients who do not produce either biomarker and still have high risk of recurrence (29,30). Therefore, pursuing other biomarkers that assess the role of inflammation in malignancy is another method to identify patients at risk of recurrence. The link between inflammation and cancer was postulated in the year 1863 by Virchow, and inflammation has been linked with several gastrointestinal malignancies (31). In the last decade, there has been increasing interest in the use of inflammatory markers as tools to predict poor outcomes in patients with HCC. This review will focus of such inflammatory markers, the role they play in HCC, and how to potentially use these as selection tools for patients awaiting transplant. Neutrophil lymphocyte ratio (NLR)The NLR is a measure of the proportion of peripheral blood neutrophils to lymphocytes and has an important role in predicting outcomes in several malignancies. An elevated NLR can be a marker of both neutrophilia in response to inflammation or peripheral lymphopenia, both first demonstrated the use of NLR in predicting outcomes for HCC in 150 patients undergoing LT for HCC. Of the 13 patients with elevated NLR, 62% had recurrence and, as a cohort, had significantly worse OS and RFS. Of note, even patients within Milan criteria with an elevated NLR, compared to those with normal NLR, had a significantly worse survival (30% vs. 81%) (36). In the largest study in the MELD era from the United States examining post-LT outcomes for HCC, the MORAL score was evaluated for its ability to predict post-LT RFS. The MORAL score was constructed using Cox-regression analyses for factors imp...

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Peritransplant Lymphopenia Is a Novel Prognostic Factor in Recurrence of Hepatocellular Carcinoma After Liver Transplantation

Abstract: Peritransplant lymphopenia is a powerful prognostic factor for the recurrence of HCC after LT, which suggests that maintaining ALCs in LT patients might improve cancer outcome.

Cited by 50 publications

References 29 publications

High pretreatment neutrophil–lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer

High pretreatment neutrophil–lymphocyte ratio predicts recurrence and poor prognosis for combined small cell lung cancer

Untitled

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

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