Preoperative lymphocyte to white blood cell ratio predicts the survival of patients with hepatocellular carcinoma after liver resection: A multicenter study 

Abstract

Background Lymphocytes play a key anticancer role. However, there is little information concerning the prognostic utility of the lymphocyte to white blood cell ratio (LWR) for patients with hepatocellular carcinoma (HCC) after liver resection. Methods The data of patients with HCC who underwent liver resection at 5 centers were retrospectively reviewed. X-Tile software was used to determine the optimal cutoff values of the inflammation-based models. Univariate and multivariate analyses were used to identify the independent risk factors for both recurrence-free survival (RFS) and overall survival (OS). Multivariate Cox proportional hazard models were used to assess the independent risk factors for RFS and OS. Results A total of 1591 patients were included in this study. The multivariate analyses revealed that LWR was an independent risk factor for both RFS (HR = 1.190, 95% CI = 1.037–1.365, P = 0.013) and OS (HR = 1.300, 95% CI = 1.098–1.539, P = 0.002) for HCC patients after liver resection. LWR showed a higher predictive capacity for both RFS and OS than other inflammation-based models for patients with HCC after tumor resection. The 5-year RFS and OS were 42.9% and 60.8%, respectively, for HCC patients with a high LWR, which were significantly higher than those with a low LWR (36.9% for RFS and 49.0% for OS, both P < 0.001). Conclusions Preoperative LWR may serve as a novel marker to predict the survival of HCC patients after liver resection. Low LWR was associated with a high incidence of postoperative recurrence and mortality.