Platelet-to-lymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma

Abstract

The platelet count, as an inflammation marker, is involved in the progress of tumor invasion. However, the prognostic value of platelet counts and the platelet-to-lymphocyte ratio (PLR) has not been investigated in patients with advanced hepatocellular carcinoma (HCC). This study aimed to determine the prognostic value of platelet counts and PLR in HCC patients. A total of 243 ethnic Chinese advanced HCC patients from two major hospitals, not receiving systemic sorafenib, were analyzed retrospectively. The prognostic value of differential blood cell counts and PLR for overall survival (OS) was determined by integrating the Cancer of the Liver Italian Program (CLIP) score system and model for end-stage liver disease by using a stepwise model of multivariate Cox regression. The Kaplan-Meier method and receiver operating characteristic (ROC) curves were utilized accordingly. PLR was confirmed to be an independent predictor for OS (p < 0.01), while the remaining parameters had no predictive value. Then, advanced HCC patients were dichotomized into two groups based on the PLR value (≤111.23 or >111.23), according to ROC analysis. Patients with a high PLR had a lower 3-month survival rate (37.6 vs. 57.6%) compared with patients with a low PLR. PLR was associated with aggressive malignant behavior, characterized by distant metastasis and portal vein thrombosis. Additionally, PLR was not associated with the CLIP score and Child-Pugh grade. PLR was identified as an independent prognostic factor for advanced HCC patients not receiving systemic sorafenib; the predictive ability of PLR partially relies on its association with the aggressive nature of HCC.

Evaluation of the prognostic value of platelet to lymphocyte ratio in patients with hepatocellular carcinoma

“…In HCC however, the results were still conflicting regarding the prognostic value of PLR to predict overall survival and the optimal cut-off of PLR remains unclear (11,(17)(18)(19)(20).…”

An HCC Aggressiveness Index and Blood GTP, Bilirubin and Platelet Levels

“…A recently validated index of systemic inflammation, using the levels of only 2 liver-derived proteins, Creactive protein (CRP) and albumin has been shown in multiple studies to be an independent prognosticator of survival [4][5][6]. The platelet to lymphocyte ratio is another recently described, independent inflammatory prognostic index for HCC [7]. In this paper, we validated the new Aggressiveness Index on a separate and much larger HCC patient cohort in relation to survival and we examined liver function parameters in relation to the index.…”

Platelet-to-lymphocyte ratio: a prognostic factor for patients with advanced hepatocellular carcinoma?

“…Dear Editor, In a recent issue of Tumor Biology, Xing Li and his colleagues published an article [1] entitled BPlatelet-tolymphocyte ratio acts as a prognostic factor for patients with advanced hepatocellular carcinoma.^In this study, the investigators aimed to determine the prognostic value of platelet-to-lymphocyte ratio in a total of 243 advanced hepatocellular carcinoma (HCC) patients from two major hospitals. The investigators concluded that patients with a high platelet-to-lymphocyte ratio (PLR) had a lower 3-month survival rate (37.6 vs. 57.6 %) compared with patients with a low PLR.…”

“…In the literature, it was shown that valvular heart diseases, acute coronary syndromes, hypertension, end-stage renal diseases, and other diseases may potentially affect the PLR [2][3][4][5][6]. In the study of Xing Li et al [1], patients with previous and/or secondary cancers were excluded, while such as heart diseases which is very common in old people (age 57 (19-86)) were not mentioned. Thus, it would be more relevant if the investigators had mentioned these PLR-affecting factors while evaluating PLR as an independent prognostic factor for advanced HCC patients.…”