Postoperative Trends and Prognostic Values of Inflammatory and Nutritional Biomarkers after Liver Transplantation for Hepatocellular Carcinoma

Abstract

Preoperative inflammatory biomarkers such as the Platelet-to-Lymphocyte Ratio (PLR) and the Neutrophil-to-Lymphocyte Ratio (NLR) strongly predict the outcome in surgically treated patients with hepatocellular carcinoma (HCC), while nutritional biomarkers such as the Controlling Nutritional Status (CONUT) and the Prognostic Nutritional Index (PNI) show an analogue prognostic value in hepatic resection (HR) but not in liver transplant (LT) cases. Data on the impact of LT on the inflammatory and nutritional/metabolic function are heterogeneous. Therefore, we investigated the post-LT trend of these biomarkers up to postoperative month (POM) 12 in 324 HCC patients treated with LT. Inflammatory biomarkers peaked in the early post-LT period but at POM 3 leveled off at values similar (NLR) or higher (PLR) than pre-LT ones. CONUT and PNI worsened in the early post-LT period, but at POM 3 they stabilized at significantly better values than pre-LT. In LT recipients with an overall survival >1 year and no evidence of early HCC recurrence, 1 year post-LT NLR and PNI independently predicted patient overall survival, while 1 year post-LT PLR independently predicted late tumor recurrence. In conclusion, at 1 year post-LT, the nutritional status of liver-transplanted HCC patients significantly improved while their inflammatory state tended to persist. Consequently, post-LT PLR and NLR maintained a prognostic value for LT outcome while post-LT CONUT and PNI acquired it.

Refining Prognosis in Chemoembolization for Hepatocellular Carcinoma: Immunonutrition and Liver Function

“…Therefore, we used optimal stratification methods to identify optimal cut-offs. However, the cut-off values used in our study fell within the range of values used on other studies conducted for Western patients [38,[56][57][58]. Nevertheless, future multicenter studies are mandatory to define universal cut-off values for Caucasian patients.…”

CONUT Score Predicts Early Morbidity After Liver Transplantation: A Collaborative Study

“…Another study from the same authors (N = 324) investigated the post-LT trend of CONUT in HCC patients, reporting worse values in the early post-LT period than the pre-LT values and a substantial improvement after the post-LT third month (33). Concerning the previously published studies exploring the role of the CONUT score in LT, our study presents some beneficial aspects.…”

Combining Preoperative and Postoperative Inflammatory Indicators Can Better Predict the Recurrence of Hepatocellular Carcinoma After Partial Hepatectomy

“…One study focused on the prognostic value of the postNLR and postPLR at 1, 3, 5, and 7 days and at 3, 6, and 12 months and revealed that the prognostic value of these indicators stabilized 3 days after liver transplantation. 32 A colorectal cancer study revealed that the postNLR on day 7 was an independent prognostic factor for DFS, but the postNLR on day 1 was not an independent prognostic indicator. 33 These two studies demonstrated that postoperative inflammatory indicators increased rapidly on the first day then declined rapidly.…”

“… 33 These two studies demonstrated that postoperative inflammatory indicators increased rapidly on the first day then declined rapidly. 32 , 33 Neutrophils are transient effector cells that undergo apoptosis in damaged tissues. 31 Therefore, due to the impact of incision and surgical stress in the early postoperative period, the inflammatory indicators in the peripheral blood cannot accurately reflect the patient’s immune status, and the prognostic value of early postoperative inflammatory indicators is limited.…”